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Best Practice & Research Clinical Gastroenterology最新文献

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Traditional septotomy or Z-POEM for Zenker's diverticulum 传统的隔膜切除术或 Z-POEM 治疗禅克氏憩室
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101943
M.F. Kaminski , A. Budnicka , A. Przybysz , N.D. Pilonis
{"title":"Traditional septotomy or Z-POEM for Zenker's diverticulum","authors":"M.F. Kaminski ,&nbsp;A. Budnicka ,&nbsp;A. Przybysz ,&nbsp;N.D. Pilonis","doi":"10.1016/j.bpg.2024.101943","DOIUrl":"10.1016/j.bpg.2024.101943","url":null,"abstract":"<div><p>Zenker's diverticulum (ZD), also known as a cricopharyngeal pouch, is a pulsion pseudodiverticulum located dorsally at the pharyngoesophageal junction. The pathophysiology of ZD involves cricopharyngeal spasm, incoordination, impaired upper esophageal sphincter opening, and structural changes in the cricopharyngeal muscle, leading to symptoms such as dysphagia, regurgitation of undigested food, foreign body sensation, halitosis, unintentional weight loss, and respiratory issues. Treatment for symptomatic ZD typically involves myotomy of the cricopharyngeal muscle. Endoscopic techniques, particularly flexible endoscopy septotomy (FES) and Zenker peroral endoscopic myotomy (Z-POEM), have become preferred options due to their minimally invasive nature. This review discusses the techniques and clinical outcomes of FES and Z-POEM, focusing on specific clinical scenarios to guide the choice between these methods. Additionally, the variability in FES techniques, the effectiveness of Z-POEM, and the impact of different diverticulum sizes on treatment outcomes are analyzed, providing a comprehensive overview of current therapeutic approaches for ZD.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101943"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
POEM for non-achalasia spastic oesophageal motility disorders POEM 用于治疗非achalasia 痉挛性食道运动障碍
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101909
{"title":"POEM for non-achalasia spastic oesophageal motility disorders","authors":"","doi":"10.1016/j.bpg.2024.101909","DOIUrl":"10.1016/j.bpg.2024.101909","url":null,"abstract":"<div><p>Non-achalasia oesophageal motility disorders (NAOMD) represent a heterogeneous group of rare diseases, including oesophagogastric junction outflow obstruction, distal oesophageal spasm, and hypercontractile oesophagus. Despite the differing aetiological, manometric and pathophysiological characteristics, these disorders are unified by similar clinical presentation, including dysphagia and chest pain. The management of these disorders remain a challenge for the clinician. Pharmacotherapy, botulinum toxin injection, endoscopic dilation, and laparoscopic Heller myotomy have been employed, with limited efficacy in the majority of patients. Currently, there are no controlled studies in literature that suggest which is the best management of these diseases. Since its introduction in clinical practice, PerOral Endoscopic Myotomy (POEM) has emerged as a very promising, minimally invasive and effective treatment for oesophageal achalasia. No longer after the first uses, POEM has been successfully used also for the management of selected patients with NAOMD, However, currently available data are limited by small study sample sizes and short-term follow-up.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101909"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521691824000313/pdfft?md5=dc0dc0e7a10f7e65d1a2ba110f1d051c&pid=1-s2.0-S1521691824000313-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140584994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
POEM in the esophagus - How to deal with the post-POEM reflux 食道中的 POEM - 如何处理 POEM 后反流问题
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101917
{"title":"POEM in the esophagus - How to deal with the post-POEM reflux","authors":"","doi":"10.1016/j.bpg.2024.101917","DOIUrl":"10.1016/j.bpg.2024.101917","url":null,"abstract":"<div><p><span><span><span><span>Reflux after peroral endoscopic myotomy (POEM) is arguably one of the greatest concerns related to the procedure. The exact incidence is difficult to establish as reflux symptoms, </span>esophagitis<span>, and abnormal acid exposure correlate poorly, warranting thorough diagnostic investigation. The incidence is, however, higher than after Heller myotomy or pneumatic dilatation across all these three parameters. Although </span></span>PPI are effective in the resolution of symptoms and healing of esophagitis, refractory patients exist. Esophageal </span>hypersensitivity and acidic fermentation/esophageal stasis are most likely causes and could be diagnosed by manual analysis of pH metry tracings. Long-term complications like peptic stricture and </span>Barrett's esophagus are rare and reported sporadically. Modifications of POEM procedure aiming to decrease post-POEM reflux led to no conclusive preferred technique. Modern investigations like endoluminal functional lumen imaging probe might help to personalize myotomy to the desired distensibility of the lower esophageal sphincter and decrease reflux.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101917"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140928823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Complications related to third space endoscopic procedures 与第三空间内窥镜手术有关的并发症
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/j.bpg.2024.101908
{"title":"Complications related to third space endoscopic procedures","authors":"","doi":"10.1016/j.bpg.2024.101908","DOIUrl":"10.1016/j.bpg.2024.101908","url":null,"abstract":"<div><p><span>Third space endoscopy<span> (TSE) encompasses a breadth of procedures for the treatment of a variety of GI disorders. The widespread use of per-oral endoscopic myotomy (POEM) and its diversification to include extended indications and at locations other than the oesophagus has provided an insight into the potential complications encountered. The most common adverse events associated with POEM, the epitome of TSE procedures, include insufflation related injuries, bleeding, failure of mucosal barrier, infections, pain, blown out myotomy and </span></span>gastroesophageal reflux disease. The purpose of this review is to highlight the pitfalls and to identify the risk factors that may lead to adverse events, and to recommend appropriate salvage interventions in the scope of the current evidence.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101908"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140322762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Copyright Information 版权信息
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-08-01 DOI: 10.1016/S1521-6918(24)00074-X
{"title":"Copyright Information","authors":"","doi":"10.1016/S1521-6918(24)00074-X","DOIUrl":"10.1016/S1521-6918(24)00074-X","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"71 ","pages":"Article 101949"},"PeriodicalIF":3.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic suturing and clipping devices for defects in the GI tract 消化道缺损的内窥镜缝合和剪切装置
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-06-01 DOI: 10.1016/j.bpg.2024.101915
{"title":"Endoscopic suturing and clipping devices for defects in the GI tract","authors":"","doi":"10.1016/j.bpg.2024.101915","DOIUrl":"10.1016/j.bpg.2024.101915","url":null,"abstract":"<div><p>Gastrointestinal luminal defects, including perforations, leaks and fistulae, pose persistent obstacles in endoscopic therapeutic interventions. A variety of endoscopic approaches have been proposed, with through-the-scope clipping (TTSC), over-the-scope clipping (OTSC) and suturing representing the main techniques of tissue apposition. However, the heterogeneity in defect morphology, the technical particularities of different locations in the gastrointestinal (GI) tract and the impact of various parameters on the final outcome, do not allow distinct conclusions and recommendations on the optimal approaches for defect closure, and, thus, current practice is based on endoscopists experience and local availability of devices. This review aims to collect the existing evidence on tissue apposition devices, in order to outline the role of every device on specific indications.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"70 ","pages":"Article 101915"},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521691824000374/pdfft?md5=33ca7c06a0e44f5fbc37ac072c200182&pid=1-s2.0-S1521691824000374-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140929022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Copyright Information 版权信息
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-06-01 DOI: 10.1016/S1521-6918(24)00059-3
{"title":"Copyright Information","authors":"","doi":"10.1016/S1521-6918(24)00059-3","DOIUrl":"10.1016/S1521-6918(24)00059-3","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"70 ","pages":"Article 101934"},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141959664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multi-modality management of defects in the gastrointestinal tract: Where the endoscope meets the scalpel: Endoscopic vacuum therapy in the upper gastrointestinal tract 胃肠道缺损的多模式治疗：内窥镜与手术刀的结合：上消化道内窥镜真空疗法
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-06-01 DOI: 10.1016/j.bpg.2024.101901
{"title":"Multi-modality management of defects in the gastrointestinal tract: Where the endoscope meets the scalpel: Endoscopic vacuum therapy in the upper gastrointestinal tract","authors":"","doi":"10.1016/j.bpg.2024.101901","DOIUrl":"10.1016/j.bpg.2024.101901","url":null,"abstract":"<div><h3>Background</h3><p>Transmural defects in the upper gastrointestinal (GI) tract, such as anastomotic leakage and oesophageal perforations, are associated with significant morbidity and mortality risks. Endoscopic vacuum therapy (EVT) is an efficient and safe treatment option for these patients. With the growing use of EVT in the upper GI tract, it is important to share expertise on the topic.</p></div><div><h3>Aim</h3><p>This review explores the emerging role of endoscopic vacuum therapy (EVT) as treatment for transmural defects in the upper GI tract. An overview of the mechanism and procedures, outcomes in current literature and challenges of implementation and application are discussed.</p></div><div><h3>Conclusion</h3><p>EVT exhibits great efficacy and safety for the treatment of transmural defects in the upper GI tract. Current use of EVT is mostly experience-based, emphasizing the importance of sharing expertise and performing research to unlock its full potential.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"70 ","pages":"Article 101901"},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521691824000209/pdfft?md5=a174069c012c27fff5fbb4ee6b959f5e&pid=1-s2.0-S1521691824000209-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140055222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Applications of endoscopic vacuum therapy in the lower gastrointestinal tract: Tips and tricks and a review of the literature 下消化道内窥镜真空疗法的应用：技巧和方法以及文献综述
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-06-01 DOI: 10.1016/j.bpg.2024.101927
{"title":"Applications of endoscopic vacuum therapy in the lower gastrointestinal tract: Tips and tricks and a review of the literature","authors":"","doi":"10.1016/j.bpg.2024.101927","DOIUrl":"10.1016/j.bpg.2024.101927","url":null,"abstract":"<div><p>Endoscopic vacuum therapy (EVT) is an established technique for the treatment of rectal wall defects and especially anastomotic leaks. A wide range of EVT devices, both handmade and commercially available, allow for their successful placement even in small defects and difficult localizations. Reported success rates range between 85 and 97 %, while periintervenional morbidity is low and major adverse events are very rare. EVT has proven its effectiveness in the lower gastrointestinal tract and is now considered first line treatment for pelvic anastomotic leaks. This narrative review summarizes the current literature on EVT in the lower gastrointestinal tract, focusing on its indications, technical aspects and results, and offers tips and tricks for its clinical applications.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"70 ","pages":"Article 101927"},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141395828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The role of radiology in diagnosing gastrointestinal tract perforation 放射学在诊断胃肠道穿孔中的作用
IF 3.2 3区 医学
Best Practice & Research Clinical Gastroenterology Pub Date : 2024-06-01 DOI: 10.1016/j.bpg.2024.101928
{"title":"The role of radiology in diagnosing gastrointestinal tract perforation","authors":"","doi":"10.1016/j.bpg.2024.101928","DOIUrl":"10.1016/j.bpg.2024.101928","url":null,"abstract":"<div><p>Spontaneous, iatrogenic or surgical perforation of the whole gastrointestinal wall can lead to serious complications, resulting in increased morbidity and mortality. Optimal patient management requires early clinical appraisal and prompt imaging evaluation. Both radiologists and referring clinicians should recognize the importance of choosing the ideal imaging modality and the usefulness of oral and rectal contrast medium. Surgeons and radiologists should be familiar with CT and fluoroscopy findings of the normal and pathologic anatomy after esophageal, stomach or colon surgery. Specifically, they should be able to differentiate innocuous from clinically-relevant, life-threatening postoperative complications to guide appropriate treatment. Advantages of esophagram, CT-esophagram, CT after rectal contrast enema and other imaging modalities are discussed.</p></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"70 ","pages":"Article 101928"},"PeriodicalIF":3.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521691824000532/pdfft?md5=887a9e377e1a1c82245edd127b3ecb4b&pid=1-s2.0-S1521691824000532-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141391525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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