Translational gastroenterology and hepatology最新文献

{"title":"Impact of immune tolerance mechanisms on the efficacy of immunotherapy in primary and secondary liver cancers.","authors":"Kamya Sankar,&nbsp;Ashley N Pearson,&nbsp;Tejaswi Worlikar,&nbsp;Matthew D Perricone,&nbsp;Erin A Holcomb,&nbsp;Mishal Mendiratta-Lala,&nbsp;Zhen Xu,&nbsp;Neil Bhowmick,&nbsp;Michael D Green","doi":"10.21037/tgh-23-11","DOIUrl":"https://doi.org/10.21037/tgh-23-11","url":null,"abstract":"<p><p>The liver is a functionally unique organ with an immunosuppressive microenvironment. The liver is the sixth most common site of primary cancer in humans and is a frequent site of metastasis from other solid tumors. The development of effective therapies for primary and metastatic liver cancer has been challenging due to the complex metabolic and immune microenvironment of the liver. The liver tumor microenvironment (TME) in primary and secondary (metastatic) liver cancers is heterogenous and consists of unique immune and stromal cell populations. Crosstalk between these cell populations and tumor cells creates an immunosuppressive microenvironment within the liver which potentiates cancer progression. Immune checkpoint inhibitors (ICIs) are now clinically approved for the management of primary and secondary liver cancer and can partially overcome liver immune tolerance, but their efficacy is limited. In this review, we describe the liver microenvironment and the use of immunotherapy in primary and secondary liver cancer. We discuss emerging combination strategies utilizing locoregional and systemic therapy approaches which may enhance efficacy of immunotherapy in primary and secondary liver cancer. A deeper understanding of the immunosuppressive microenvironment of the liver will inform novel therapies and therapeutic combinations in order to improve outcomes of patients with primary and secondary liver cancer.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"8 ","pages":"29"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5c/58/tgh-08-23-11.PMC10432235.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenoma detection rate <i>vs</i>. adenoma per colonoscopy as quality indicators for colon cancer screening.","authors":"Rizwan Ishtiaq,&nbsp;Laraib Zulfiqar,&nbsp;Manesh Kumar Gangwani,&nbsp;Muhammad Aziz","doi":"10.21037/tgh-22-92","DOIUrl":"https://doi.org/10.21037/tgh-22-92","url":null,"abstract":"is known as the ‘One and done’ approach. In operators who are focused on using ADR as a quality indicator, it is very well possible that they may perform a quality examination until they find one adenoma and then unintentionally decrease the quality of the rest of the examination of the colonoscopy, which will indirectly affect the quality of the procedure without affecting ADR (7). Additionally, operator-based variability is also exhibited by differences in proximal and distal adenoma detection rate, and ADR metric by its calculable metric standard cannot account for these differences (8)","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":"8 ","pages":"24"},"PeriodicalIF":3.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2f/21/tgh-08-22-92.PMC10432231.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10406182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying optimal therapies in patients with advanced hepatocellular carcinoma: a systematic review and network meta-analysis.","authors":"Zhenyu Yang,&nbsp;Yao Tong,&nbsp;Lin Yang,&nbsp;Xianli He,&nbsp;Guoqiang Bao,&nbsp;Xilin Du","doi":"10.21037/tgh-20-318","DOIUrl":"https://doi.org/10.21037/tgh-20-318","url":null,"abstract":"<p><strong>Background: </strong>Recently, increasing literature has been reported on optimal therapies in patients with advanced hepatocellular carcinoma (HCC) and many therapeutic modalities have been proposed to improve the survival rate. However, the results are not consistent due to different research protocols, small sample sizes and different study endpoints and there is no standard treatment protocol has been defined. Therefore, it is very important to explore the optimal bonding mode and to evaluate the efficacy and safety of the optimal sequential therapy for those patients.</p><p><strong>Methods: </strong>We searched available databases through January 2020 for relevant studies. The main outcome measure was 1-year overall survival (OS) and overall response rate (ORR); the secondary outcome measure was a composite of toxic effects retrieved grade 3 or 4 adverse events (AEs) from all included studies. Statistical analyses were conducted using STATA version 15 and GeMTC package in the R statistical software.</p><p><strong>Results: </strong>After a detailed review, 8 randomized controlled trials (RCTs) and 20 retrospective studies involving 3,675 advanced HCC patients were included for network meta-analysis. Indirect comparisons showed that hepatic arterial infusion chemotherapy (HAIC) plus radiofrequency ablation (RFA) was highest probability of obtaining the best OS rate of 1 year [surface under the cumulative ranking (SUCRA), 0.95] and ORR (SUCRA, 0.86) when compared with other potential optimal therapies and which had ranked the first in all treatment regimens, followed by HAIC (SUCRA, 0.75). Direct and indirect comparison of 1-year OS and ORR with all treatment regimens each other showed that for all treatment regimens, patients showed significant clinical benefit when compared with transcatheter arterial chemoembolization (TACE) or sorafenib alone. However, the incidence of treatment-related AEs of grade 3 or 4 occurred in patients who have received targeted drug sorafenib therapy (SUCRA, 0.51) compared with other interesting regimens.</p><p><strong>Conclusions: </strong>HAIC may be a valuable therapeutic strategy for advanced HCC patients to prevent recurrence and metastasis after RFA, as well as in improving patient prognosis and quality of life. Meanwhile, HAIC combined with RFA is a safe and effective treatment in patients with advanced HCC, and this combination therapy can significantly prolong 1-year survival rate when compared with other optimal sequential therapies.</p><p><strong>Trial registration: </strong>This study is registered with PROSPERO, number CRD42020176149.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":" ","pages":"38"},"PeriodicalIF":3.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/49/6e/tgh-07-20-318.PMC9468989.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40431623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azithromycin versus erythromycin infusions prior to endoscopy in upper gastrointestinal bleeding.","authors":"Danny Issa,&nbsp;Sanjeev Solomon,&nbsp;Jonathan Hillyard,&nbsp;Brian Di Pace,&nbsp;Christopher Young,&nbsp;Patricia Uber,&nbsp;Adam Sima,&nbsp;Reem Sharaiha,&nbsp;George Smallfield","doi":"10.21037/tgh-20-51","DOIUrl":"https://doi.org/10.21037/tgh-20-51","url":null,"abstract":"<p><strong>Background: </strong>Intravenous erythromycin prior to endoscopy for upper gastrointestinal bleeding (GIB) improves outcomes but requires immediate preparation delaying administration in emergency cases. Azithromycin is readily available and does not require prolonged preparation. The aim of the study was to assess the effect of azithromycin in improving the quality of endoscopic visualization in upper GIB compared to erythromycin.</p><p><strong>Methods: </strong>Patients admitted with upper GIB who received erythromycin or azithromycin before urgent endoscopy were included. Primary outcome of the quality of visualization was assessed by two gastroenterologists, blinded to the choice of infusion, using a scoring system ranging from 0 to 8, with a maximum of 2 points assigned to the fundus, body, antrum and bulb.</p><p><strong>Results: </strong>Sixty-six patients were included; 25 received azithromycin and 41 received erythromycin. Mean total visualization score was significantly higher with azithromycin compared to that with erythromycin (6.8±1.4 <i>vs.</i> 5.5±2.2, respectively; P=0.01) and remained significant after adjusting for confounders (Diff: 0.01, 1.88; P=0.05). Secondary outcomes analyses showed a shorter LOS when given azithromycin compared to erythromycin [6 (3 to 9) <i>vs.</i> 8 (7 to 16) days, respectively, 95% CI: 1.03, 3.89; P=0.04]. Time between initiating the infusion and endoscopy was longer with azithromycin (Diff: 40.64 min; 95% CI: 7.23, 74.05; P=0.02). Need for second look endoscopy, procedure time, blood transfusion requirements and procedure-related complications did not differ between the groups.</p><p><strong>Conclusions: </strong>Azithromycin infusion before endoscopy for upper GIB was associated with better visualization than that of erythromycin. Randomized trials are needed to validate these findings.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":" ","pages":"35"},"PeriodicalIF":3.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e6/5f/tgh-07-20-51.PMC9468987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40431624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance imaging in primary sclerosing cholangitis (PSC): evidence, patient preference and physician autonomy.","authors":"Philip A Berry,&nbsp;Sreelakshmi Kotha","doi":"10.21037/tgh-21-87","DOIUrl":"https://doi.org/10.21037/tgh-21-87","url":null,"abstract":"Transl Gastroenterol Hepatol 2022;7:43 | https://dx.doi.org/10.21037/tgh-21-87 Rabiee and Silveira’s recent article on primary sclerosing cholangit i s (PSC) comments on survei l lance for cholangiocarcinoma, and highlights an area of ongoing controversy (1). They write, ‘Though guidelines do not universally recommend surveillance for CCA a retrospective study including 79 patients with PSC who developed hepatobiliary cancer revealed that patients who underwent surveillance had a significantly improved 5-year survival compared to the nosurveillance group (68% vs. 20%).’ Current guidelines in the United Kingdom advise a conservative approach, with magnetic resonance imaging (MRI) recommended only if clinical condition changes (2). Clinicians have argued against this, citing studies suggestive of clinical benefits from routine surveillance and contradictory advice from international societies (3). As in other areas of medicine, decisions around surveillance need to take into account overall clinical and economic factors. If hundreds of thousands of patients with a certain condition require surveillance annually, the threshold at which this should commence will have a huge impact on resources. Correspondingly, a physician who elects to scan their patients annually because they interpret the evidence differently could be criticised. Despite this, there is enough latitude in most health systems for doctors and patients to settle on an approach that is comfortable for them. Given that PSC is rare, but carries a risk of cholangiocarcinoma in 10–15% of patients, the economic argument may be less relevant, justifying a more individualised approach. During the COVID-19 pandemic the ‘precautionary principle’ has been used to justify the wearing of masks in the absence of strong evidence (4). The public are now more aware of the evidence-based practice and guidance, and of the difficulties that waiting for large, well-designed trials presents. Are present dangers and associated unknowns sufficient to overthrow evidencebased principles? What if we deny a generation of patients’ surveillance now, but learn in ten years’ time that lives could have been saved? And where do patients’ preferences come into this debate? Uncertainty about prognosis is associated with morbidity in PSC (5). Patients have expressed strong desires to the authors of this letter to have regular scans, in order to know how their disease is progressing and perhaps have some sense of control. Conversely, we know that surveillance can be associated with physical and psychological harms. Presently, hepatologists and patients are caught in a conflicted, uncertain zone; together they must find a path between guidance, patient preference and physician autonomy. While research continues into the effectiveness of surveillance in PSC, patient preferences and the effect on well-being should be studied in parallel.","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":" ","pages":"43"},"PeriodicalIF":3.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/22/a3/tgh-07-21-87.PMC9468984.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40452592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could immune activation cause pancreatitis in COVID-19 patients?","authors":"Gabriela Gama Freire Alberca,&nbsp;Naiane Samira Souza Cardoso,&nbsp;Ricardo Wesley Alberca","doi":"10.21037/tgh-21-21","DOIUrl":"https://doi.org/10.21037/tgh-21-21","url":null,"abstract":"","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":" ","pages":"45"},"PeriodicalIF":3.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/65/tgh-07-21-21.PMC9469009.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40452595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to a primer to image enhanced endoscopy.","authors":"","doi":"10.21037/tgh-22-78","DOIUrl":"https://doi.org/10.21037/tgh-22-78","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.21037/tgh-2020-07.].</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":" ","pages":"46"},"PeriodicalIF":3.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/72/tgh-07-22-78.PMC9468981.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40431622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Filling the diagnostic gap in follow-up after liver transplantation.","authors":"Christoph Eisenbach","doi":"10.21037/tgh-20-284","DOIUrl":"https://doi.org/10.21037/tgh-20-284","url":null,"abstract":"","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":" ","pages":"33"},"PeriodicalIF":3.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/2b/tgh-07-20-284.PMC9468982.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40452590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and the liver: a narrative review of the present state of knowledge.","authors":"Ragesh B Thandassery,&nbsp;Jonathan A Dranoff,&nbsp;Abhilash Perisetti,&nbsp;Tamar Taddei","doi":"10.21037/tgh-20-243","DOIUrl":"https://doi.org/10.21037/tgh-20-243","url":null,"abstract":"<p><p>Novel corona virus disease (COVID-19) is an ongoing pandemic that has spread across the globe. The virus primarily infects type-2 pneumocytes in alveoli and causes lung disease, with severity ranging from mild pneumonia to acute respiratory distress syndrome. The virus also invades gastrointestinal epithelial cells, hepatocytes, and biliary epithelial cells. Derangement of liver function tests is noted in about one third of patients and appears to correlate with more severe disease. There are multiple mechanisms by which the virus can cause liver injury; immune-mediated inflammation and direct viral cytotoxicity are believed to be the predominant mechanisms. Liver injury appears to be transient, usually recovering with resolution of illness. Limited available studies and experience from prior corona virus pandemics seem to suggest that immunosuppressed patients have similar outcomes compared to non-immunosuppressed patients. Age and comorbid conditions seem to influence outcome, irrespective of immune status. Additionally, patients with preexisting comorbid conditions are more prone to acquire infection and should strictly adhere to travel and social distancing advisories. Telemedicine should be utilized to provide uninterrupted care for patients with liver disease, and clinic or hospital visits should be advised only in sick patients with advanced liver disease. In conclusion, liver dysfunction is not uncommon in COVID-19, it generally improves with resolution of disease, and patients with chronic liver disease (CLD) need continued follow up, uninterrupted by the ongoing pandemic, preferably in virtual clinic settings.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":" ","pages":"40"},"PeriodicalIF":3.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/96/tgh-07-20-243.PMC9468988.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40452591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing a CT esophagram protocol after flexible endoscopic diverticulotomy for Zenker's diverticulum: a retrospective series.","authors":"Debdeep Banerjee,&nbsp;Laura L Magnelli,&nbsp;Mailin Oliva,&nbsp;Neha Malik,&nbsp;Brittney M Ginsburg,&nbsp;Joseph R Grajo,&nbsp;Tony S Brar,&nbsp;Donevan R Westerveld,&nbsp;Dennis Yang,&nbsp;Peter V Draganov","doi":"10.21037/tgh-20-269","DOIUrl":"https://doi.org/10.21037/tgh-20-269","url":null,"abstract":"<p><strong>Background: </strong>Flexible endoscopic cricopharyngeal myotomy and septotomy offer a minimally invasive transluminal option for the treatment of symptomatic Zenker's diverticulum (ZD). There is currently no consensus regarding postoperative follow-up imaging. We suggest a standardized computed tomography (CT) esophagram protocol for radiographic evaluation of postoperative findings.</p><p><strong>Methods: </strong>Single center retrospective analysis of patients with symptomatic ZD who underwent flexible endoscopic diverticulotomy and postoperative imaging with CT esophagram from January 2015 to March 2020. An experienced radiologist blinded to the initial imaging reports prospectively interpreted all CT esophagram findings, in order to minimize bias.</p><p><strong>Results: </strong>Twenty-one patients underwent CT esophagram following flexible endoscopic diverticulotomy for ZD. Diverticulotomy was technically successful in all patients. Most common findings on imaging included: atelectasis (13/21; 62%), persistent esophageal diverticulum (7/21; 33%), pneumomediastinum (3/21; 14%), aspiration (2/21; 10%), and extraluminal air and contrast extravasation consistent with focal esophageal perforation (1/21; 5%).</p><p><strong>Conclusions: </strong>We describe a standardized, simple, and accessible CT esophagram protocol for postoperative imaging of patients with post-flexible endoscopic cricopharyngeal myotomy and septotomy for ZD. CT esophagram facilitates a definitive exclusion of focal esophageal perforation as a postoperative complication of flexible endoscopic diverticulotomy by ruling out extraluminal air and contrast extravasation.</p>","PeriodicalId":23267,"journal":{"name":"Translational gastroenterology and hepatology","volume":" ","pages":"34"},"PeriodicalIF":3.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/2d/1b/tgh-07-20-269.PMC9469010.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40452593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}