Gastroenterology and Functional Medicine最新文献

{"title":"Contemporary diagnosis and management of gallbladder polyps","authors":"Theodoros E. Pavlidis, Ioannis N Galanis","doi":"10.54844/gfm.2023.508","DOIUrl":"https://doi.org/10.54844/gfm.2023.508","url":null,"abstract":"Gallbladder (GB) polyps are present in 5%–10% of the general population and consist of true neoplastic polyps (adenomas) and pseudopolyps (predominantly cholesterol, inflammatory, hyperplastic, focal adenomyomatosis). True polyps, although relatively rare neoplastic lesions (0.5%) are considered an important factor in malignant transformation and cancer development (5%) when their size is ≥ 1 cm. Given that it is essential to diagnose GB adenocarcinoma at an early stage to optimize therapeutic management, controversy exists about whether cholecystectomy is always necessary. Their imaging characteristics, size ≥ 1 cm, age > 50 years and genetic predisposition determine the indications for immediate cholecystectomy. In younger patients with polyps < 1 cm in size and without a familial history of GB carcinoma, imaging follow-up by ultrasound (US) seems to be a reasonable recommended policy. A scoring system by multivariate analysis (cross-sectional area > 123 mm2, positive blood flow signal, age > 55.5 years, alanine aminotransferase (ALT) levels > 50 U/L and an ALT/AST (aspartate aminotransferase) ratio > 0.77) can accurately predict true polyps. The widely accepted size threshold for US follow-up is 7 mm, and for intervention, it is 10 mm. Computed tomography or better magnetic resonance imaging can overcome any misdiagnosis of conventional US incidental findings alone that may lead to potentially unnecessary operations. In challenging cases, high-resolution US, novel three-dimensional US, endoscopic US or contrast-enhanced endoscopic US could be helpful. Novel microflow imaging can safely predict polyps. Risk factors for malignancy include age > 60 years, large gallstones, primary sclerosing cholangitis, Asian ethnicity and sessile polyps accompanied by focal gallbladder wall thickening > 4 mm. For polyps sized 6–9 mm, the absence of growth at recommended follow-up (6 months, one year, and two years) indicates treatment discontinuation; however, it is not required for size < 5 mm without risk factors. In addition to laparoscopic cholecystectomy, the standard management, novel interventional modalities preserving the GB in selected cases include per-oral transmural endoscopic resection of GB polyps after a bridge of endoscopic US-guided cholecystostomy or laparoscopic gallbladder-preserving polypectomy. Generally, there are still no precise and strong evidence-based guidelines; thus, the management policy of GB polyps should be individualized in ambiguous cases.","PeriodicalId":137309,"journal":{"name":"Gastroenterology and Functional Medicine","volume":"112 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139155012","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":"Radiologic imaging utilization in the diagnosis of acute pancreatitis","authors":"Simone A. Jarrett, Sujani Yadlapati, Kevin B. Lo, Brenda Chiang, J. M. M. Manzano, Ahmad Raja, Jordan Carty, N. Musoke, Camila Salazar, Lisa Barrett, Ammaar Wattoo, Z. Azmaiparashvili, Daniel Baik","doi":"10.54844/gfm.2023.480","DOIUrl":"https://doi.org/10.54844/gfm.2023.480","url":null,"abstract":"Background and objectives: Acute pancreatitis is a major cause of hospitalizations in the United States. Imaging is often unwarranted in early, uncomplicated pancreatitis however can prove to be useful in specific clinical scenarios. This study aimed to investigate whether our institution overutilizes abdominal imaging in diagnosis of pancreatitis. Methods: Patients with acute pancreatitis admitted to our institution between 2015 and 2020 were identified using the International Classification of Diseases diagnosis codes. A total of 669 patients met the criteria for acute pancreatitis according to the revised Atlanta Classification. The data was presented using frequencies and percentages and patients with abdominal imaging were compared to those without. Mann Whitney U test and chi-square test were used to compare continuous and categorical variables respectively. Univariable and multivariable regression analysis was used to analyze factors associated with the performance of abdominal imaging. Results: Our results found that 495 patients (74%) had an abdominal computerized tomography (CT) scan, while 363 patients (52%) had an abdominal ultrasound. More than half of the patients who already met 2 out of 3 clinical and laboratory criteria of the revised Atlanta classification still underwent abdominal imaging, even though it was not necessary. However, we found no significant difference in outcomes between patients who underwent imaging and those who did not, including the need for mechanical ventilation, intensive care unit admission, and inpatient death. Conclusion: A significant number of patients admitted for acute pancreatitis undergo abdominal imaging even after fulfilling clinical and laboratory diagnostic criteria.","PeriodicalId":137309,"journal":{"name":"Gastroenterology and Functional Medicine","volume":"22 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139155336","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":"Retrospective analysis of endoscopic dilatation for pediatric patients with esophageal stricture: Bangladesh perspective","authors":"R. Rashid","doi":"10.54844/gfm.2023.429","DOIUrl":"https://doi.org/10.54844/gfm.2023.429","url":null,"abstract":"Background and objectives: Esophageal stricture in children is an intrinsic narrowing of the esophagus due to different etiologies, including congenital anomalies, corrosive substance or foreign body ingestion, and post-esophageal surgeries. The purpose of this study is to retrospectively evaluate the results and procedures of endoscopic dilatation (ED) performed on children with esophageal strictures in a specialized center in Bangladesh. Methods: Between September 2018 and October 2022, 21 children aged 0.2 to 15 years at the time of the first procedure who underwent 48 ED sessions were included at Bangladesh Specialized Hospital (Dhaka, Bangladesh). We documented the basic characteristics of patients, indications for ED, therapeutic procedures, and outcomes. Outcome parameters were the frequency of dilatations, complications (if any), and clinical success rates. Clinical success was defined as no necessity of ED for a minimum of one year or increasing intervals among repeated dilatations. Results: Among the studied patients, the most common causes of stricture were congenital esophageal atresia and ingestion of corrosive substances. More than half of the studied patients required multiple ED sessions, with one patient requiring eight sessions who had congenital esophageal atresia with a postsurgical stricture. Dilatation was achieved mostly using Savary-Gilliard or controlled radial expansion balloons varying in sizes between 8.0 mm to 30 mm. More than 76% of the studied patients had clinical success, while the rest had clinical failures or unfinished treatment. Conclusion: ED attained good clinical success if performed by skilled gastroenterologists. However, repeated dilatation is frequent, especially in patients with a corrosive-caused stricture.","PeriodicalId":137309,"journal":{"name":"Gastroenterology and Functional Medicine","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115179584","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":"Gardner syndrome: a mini review","authors":"H. Chela, M. Gandhi, Mohammad Hazique, Hamza Ertugrul, Karthik Gangu","doi":"10.54844/gfm.2023.360","DOIUrl":"https://doi.org/10.54844/gfm.2023.360","url":null,"abstract":"Gardner syndrome is one of the hereditary gastrointestinal cancer syndromes and is not commonly encountered. It is a variant of familial adenomatous polyposis associated with cutaneous and soft tissue tumors. It is important to be aware of these syndromes as they are often associated with systemic manifestations and have implications for family members.","PeriodicalId":137309,"journal":{"name":"Gastroenterology and Functional Medicine","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132670712","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":"The role of 3D printing, virtual and augmented reality in liver surgery: The technological imperative!","authors":"C. Kakos, A. Piachas, I. Karolos, G. Tsoulfas","doi":"10.54844/gfm.2023.383","DOIUrl":"https://doi.org/10.54844/gfm.2023.383","url":null,"abstract":"Technological innovation has been proven a valuable tool in the modern era of liver surgery. 3-dimensional (3D) printing along with virtual and augmented reality (VR and AR), as part of this technological development, can contribute to avoid high-risk complications during liver surgery. More specific, in terms of liver transplantation, small-for-size and large-for-size syndromes can be avoidable with timely utilization of these modalities, by measuring the volume of both the donor’s liver and recipient’s abdomen. Additionally, artificial bio-printed livers have the potential to minimize the shortage of grafts, yet this novelty needs further development. The same artificial livers can participate in clinical trials of drugs’ hepatotoxicity, removing the risk from living human beings. In hepatic resection, the employment of VR can help hepatobiliary surgeons identify and comprehend the complexity of the anatomic structures of liver parenchyma, especially the related vessels and biliary branches. VR and AR represent new alternatives for the traditional 3D printed models, especially after the increasing availability of relevant medical applications outweighing the disadvantages of 2D models. Apart from their surgical applications, VR and AR can play a valuable role with regards to medical education, not only for medical students, but also for surgical trainees as several studies have shown. Certain limitations, such as those associated with the cost and the time required to generate a 3D prototype, tent to be eliminated due to VR and AR. Unambiguously, further evolution of thistechnology will lead to wider application for the best of patients’ care and perfection of surgical outcomes.","PeriodicalId":137309,"journal":{"name":"Gastroenterology and Functional Medicine","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125232762","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":"Renal response of solute carrier transporters and related proteins in obstructive jaundice","authors":"A. Torres","doi":"10.54844/gfm.2023.334","DOIUrl":"https://doi.org/10.54844/gfm.2023.334","url":null,"abstract":"Obstructive jaundice mainly takes place after cholelithiasis and neoplasms that affect the pancreas and the common bile duct. The liver and kidney eliminate toxins, pharmacotherapeutic drugs, and endogenous metabolites. It has been reported that the alteration of one route of excretion can be compensated by the other route. Modifications in the expression of several carrier proteins have been observed after the impairment of the hepatic function. The present work updates the modifications reported in the renal expression and in the urinary levels of some proteins belonging to the solute carrier family (such as Oatp1, Oat1, Oat3, Oat5, Asbt, and NKCC2) and some proteins related in some way to these ones (such as AQP2,Cav-1, and Cav-2). An increased renal expression of Oatp1, Oat1, Oat3, Oat5, and a decreased abundance of Abst was observed after 21 h of bile duct ligation, explaining the increase in the renal clearance of different compounds that could not be excreted by the liver because the biliary excretion is impaired. Moreover, the decreased expression of NKCC2 and AQP2 together with the increase in medullary renal blood flow could account for the increase in the urinary flow previously reported in this pathological state. In addition, a decreased expression of Cav-1 and an increased expression of Cav-2 in kidneys were reported in the early phase of acute cholestasis. It is well-known that renal function is altered during cholestasis and that the impairment of this organ increases with the time course of cholestasis. Increase urinary levels of NaDC1, Cav-1, andCav-2 together with a decrease of Oat5, plus the absence of modifications of NKCC2 and AQP2 were detected after 21 h of bile duct ligation in the absence of alterations in traditional parameters of renal function. Thus, the urinary levels of these proteins were proposed as a novel panel of biomarkers of the early phase of acute obstructive jaundice.","PeriodicalId":137309,"journal":{"name":"Gastroenterology and Functional Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130972882","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}