BACKGROUND Single-balloon enteroscopy(SBE)is a minimally invasive procedure to assess and treat small bowel pathologies.The most common use is to detect suspected small bowel bleeding:Insignificant gastrointestinal(GI...BACKGROUND Single-balloon enteroscopy(SBE)is a minimally invasive procedure to assess and treat small bowel pathologies.The most common use is to detect suspected small bowel bleeding:Insignificant gastrointestinal(GI)bleeding or iron deficiency anaemia(IDA).The safety and feasibility of SBE in the elderly has not been adequately studied.AIM To assess the safety and feasibility of both antegrade and retrograde SBE in elderly patients.METHODS We performed a retrospective cohort study of all antegrade and retrograde SBE done at our center from March 2011 through May 2020.We collected patient’s data including demographics,indications,findings,therapeutic interventions,and complications.The cohort was divided into 3 groups:Patients younger than 65 years(group 1),patients 65-75 years(group 2),and patients older than 75 years(group 3).We used 1-way one way analysis of variance,aχ^(2) test,and logistic regression to compare study outcomes.The primary aim was to assess diagnostic yield,therapeutic yield and rates of complications from SBE among study groups.RESULTS A total of 284 SBE were performed in 227 patients.In the 227 patients,we analyzed 194 antegrade(19 in gastric bypass patients)and 33 retrograde procedures.Mean age was 62.0(SD:16.7),130 patients were women(57.3%),98 were Hispanic(43.4%),and mean body mass index was 28(SD:6.3).The number of patients in each group were:Group 1(117,51.3%),group 2(57,25.0%)and group 3(53,23.7%).Gender,ethnicity,body mass index and proportions of antegrade and retrograde were comparable between age groups.The most common indications for procedure were:Obscure GI bleeding(48%),IDA(48%),abdominal pain(14%),and others(abnormal capsule,43%;abnormal imaging,9.7%;diarrhea 5.3%).The elderly(group 3)were more likely to have GI bleed as the indication(42.7%,40.4%,67.9%,P=0.004)without difference in IDA(44.4%,56.1%,47.2%,P=0.35).Diagnostic yield was significantly higher in the elderly group(48.2%,53.7%,68.0%),particularly in antegrade(48.5%,53.3%,72.1%,P=0.033).Angioectasias were the most common finding(21.0%)and present more often in the elderly(10.9%,20.4%,44%)(P<0.001).Therapeutic interventions were also more in the elderly group(35.0%,33.3%,58.5%,P=0.007).There were only 2(0.9%)complications,including minor oropharyngeal hemorrhage and esophageal trauma and no deaths,with no difference among groups.CONCLUSION In a retrospective analysis of SBE,we found this procedure safe and feasible in the elderly.SBE has higher diagnostic and therapeutic yields in the elderly vs the other age groups,mainly because of the increased small bowel angioectasias.展开更多
Melatonin is a hormone with endocrine, paracrine andautocrine actions. It is involved in the regulation of multiple functions, including the control of the gastroin-testinal (GI) system under physiological and pathoph...Melatonin is a hormone with endocrine, paracrine andautocrine actions. It is involved in the regulation of multiple functions, including the control of the gastroin-testinal (GI) system under physiological and pathophys-iological conditions. Since the gut contains at least 400times more melatonin than the pineal gland, a reviewof the functional importance of melatonin in the gutseems useful, especially in the context of recent clinicaltrials. Melatonin exerts its physiological effects throughspecific membrane receptors, named melatonin-1 re-ceptor (MT1), MT2 and MT3. These receptors can befound in the gut and their involvement in the regulationof GI motility, inflammation and pain has been reportedin numerous basic and clinical studies. Stable levels ofmelatonin in the lower gut that are unchanged follow-ing a pinealectomy suggest local synthesis and, further more, implicate physiological importance of endogenous melatonin in the GI tract. Presently, only a small number of human studies report possible beneficial and also possible harmful effects of melatonin in case reports and clinical trials. These human studies include patients with lower GI diseases, especially patients with irritable bowel syndrome, inflammatory bowel disease and colorectal cancer. In this review, we summarize the presently available information on melatonin effects in the lower gut and discuss available in vitro and in vivo data. We furthermore aim to evaluate whether melatonin may be useful in future treatment of symptoms or diseases involving the lower gut.展开更多
The diagnosis of gastrointestinal(GI) disorders is usually based on invasive techniques such as endoscopy.A key important factor in GI cancer is early diagnosis which warrants development of non-or lessinvasive diagno...The diagnosis of gastrointestinal(GI) disorders is usually based on invasive techniques such as endoscopy.A key important factor in GI cancer is early diagnosis which warrants development of non-or lessinvasive diagnostic techniques.In addition,monitoring and surveillance are other important parts in the management of GI diseases.Metabolomics studies with nuclear magnetic resonance and mass spectrometry can measure the concentration of more than 3000 chemical compounds in the urine providing possible chemical signature in different diseases and during health.In this review,we discuss the urinary metabolomics signature of different GI diseases including GI cancer and elaborate on how these biomarkers could be used for the classification,early diagnosis and the monitoring of the patients.Moreover,we discuss future directions of this still evolving field of research.展开更多
BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enterosco...BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enteroscopy(TTSE),a novel technique for evaluation of the small bowel.AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.METHODS Clinical data and complications of retrograde TTSE(2014-2018)and retrograde SBE(2011-2018)performed in a community hospital were reviewed and presented as mean±SD or frequency(%)and compared using proper statistical tests.Technical success was defined as insertion of the enteroscope>20 cm beyond ileocecal valve.RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied.The most common indication for retrograde enteroscopy was iron deficiency anemia(41 patients)followed by gastrointestinal bleeding(37 patients),and chronic diarrhea(7 patients).The duration of retrograde SBE procedure(91.9±34.2 min)was significantly longer compared with retrograde TTSE(70.5±30.7 min)(P=0.04).Technical success was comparable in TTSE[23/27(85.2%)]and SBE[41/54(75.9%)(P=0.33)].The mean depth of insertion beyond the ileocecal valve in retrograde SBE(92.5±70.0 cm)tended to be longer compared with retrograde TTSE(64.6±49.0 cm)(P=0.08).No complication was observed in this study.CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe.Retrograde TTSE takes a shorter time and has a comparable technical success with SBE.TTSE has a lower capacity of small bowel insertion.展开更多
BACKGROUND A recent expert panel issued recommendations about the technical aspects of direct endoscopic necrosectomy(DEN) for pancreatic walled-off necrosis(WON).However, significant technical heterogeneity still exi...BACKGROUND A recent expert panel issued recommendations about the technical aspects of direct endoscopic necrosectomy(DEN) for pancreatic walled-off necrosis(WON).However, significant technical heterogeneity still exists among endoscopists.AIM To report the outcomes of our DEN technique and how it differs from a recent expert consensus statement and previous studies.METHODS Medical records of patients with WON who underwent DEN from September2016-May 2019 were queried for the following information: Age, gender,ethnicity, etiology of acute pancreatitis, WON location and size, DEN technical information, adverse events(AEs) and outcomes. Adverse events were graded according to the American Society of Gastrointestinal Endoscopy Lexicon grading system. Technical success was defined as adequate lumen apposing metal stent(LAMS) deployment plus removal of ≥ 90% of necrosum. Clinical success was defined as complete resolution of WON cavity by imaging and resolution of symptoms at ≤ 3 months(mo) after last DEN. Data analysis was performed using mean and standard deviation for continuous variables,frequency and proportion for categorical variables, and median and range for interval data.RESULTS A total of 21 patients underwent DEN. Most of them were Hispanic and their mean age was 51 ± 17 years. The majority of the collections were located in the body of the pancreas and the mean size was 13 cm ± 5 cm. The most common indication was persistent vomiting. Antibiotics were administered only in cases of infected necrosis. All LAMS were placed without radiological guidance,dilated the same day of deployment and removed after a mean of 27 ± 11 d.Routine cross-sectional imaging immediately after drainage was not performed.The mean interval between DEN sessions was 7 ± 4 d and the mean number of DEN/patient was 3 ± 2. Technical and clinical success rates were both 95%. AEs were seen in 5 patients and included: Sepsis(2), stent migration(1), stent maldeployment(1), perforation(1). The sensitivity and positive predictive value of an occluded LAMS leading to sepsis was 50% and 0.11 respectively. No fatalities were observed.CONCLUSION Our DEN technique differed significantly from the one recommended by a recent expert panel and the one published in previous studies. Despite these differences excellent clinical outcomes were obtained.展开更多
文摘BACKGROUND Single-balloon enteroscopy(SBE)is a minimally invasive procedure to assess and treat small bowel pathologies.The most common use is to detect suspected small bowel bleeding:Insignificant gastrointestinal(GI)bleeding or iron deficiency anaemia(IDA).The safety and feasibility of SBE in the elderly has not been adequately studied.AIM To assess the safety and feasibility of both antegrade and retrograde SBE in elderly patients.METHODS We performed a retrospective cohort study of all antegrade and retrograde SBE done at our center from March 2011 through May 2020.We collected patient’s data including demographics,indications,findings,therapeutic interventions,and complications.The cohort was divided into 3 groups:Patients younger than 65 years(group 1),patients 65-75 years(group 2),and patients older than 75 years(group 3).We used 1-way one way analysis of variance,aχ^(2) test,and logistic regression to compare study outcomes.The primary aim was to assess diagnostic yield,therapeutic yield and rates of complications from SBE among study groups.RESULTS A total of 284 SBE were performed in 227 patients.In the 227 patients,we analyzed 194 antegrade(19 in gastric bypass patients)and 33 retrograde procedures.Mean age was 62.0(SD:16.7),130 patients were women(57.3%),98 were Hispanic(43.4%),and mean body mass index was 28(SD:6.3).The number of patients in each group were:Group 1(117,51.3%),group 2(57,25.0%)and group 3(53,23.7%).Gender,ethnicity,body mass index and proportions of antegrade and retrograde were comparable between age groups.The most common indications for procedure were:Obscure GI bleeding(48%),IDA(48%),abdominal pain(14%),and others(abnormal capsule,43%;abnormal imaging,9.7%;diarrhea 5.3%).The elderly(group 3)were more likely to have GI bleed as the indication(42.7%,40.4%,67.9%,P=0.004)without difference in IDA(44.4%,56.1%,47.2%,P=0.35).Diagnostic yield was significantly higher in the elderly group(48.2%,53.7%,68.0%),particularly in antegrade(48.5%,53.3%,72.1%,P=0.033).Angioectasias were the most common finding(21.0%)and present more often in the elderly(10.9%,20.4%,44%)(P<0.001).Therapeutic interventions were also more in the elderly group(35.0%,33.3%,58.5%,P=0.007).There were only 2(0.9%)complications,including minor oropharyngeal hemorrhage and esophageal trauma and no deaths,with no difference among groups.CONCLUSION In a retrospective analysis of SBE,we found this procedure safe and feasible in the elderly.SBE has higher diagnostic and therapeutic yields in the elderly vs the other age groups,mainly because of the increased small bowel angioectasias.
文摘Melatonin is a hormone with endocrine, paracrine andautocrine actions. It is involved in the regulation of multiple functions, including the control of the gastroin-testinal (GI) system under physiological and pathophys-iological conditions. Since the gut contains at least 400times more melatonin than the pineal gland, a reviewof the functional importance of melatonin in the gutseems useful, especially in the context of recent clinicaltrials. Melatonin exerts its physiological effects throughspecific membrane receptors, named melatonin-1 re-ceptor (MT1), MT2 and MT3. These receptors can befound in the gut and their involvement in the regulationof GI motility, inflammation and pain has been reportedin numerous basic and clinical studies. Stable levels ofmelatonin in the lower gut that are unchanged follow-ing a pinealectomy suggest local synthesis and, further more, implicate physiological importance of endogenous melatonin in the GI tract. Presently, only a small number of human studies report possible beneficial and also possible harmful effects of melatonin in case reports and clinical trials. These human studies include patients with lower GI diseases, especially patients with irritable bowel syndrome, inflammatory bowel disease and colorectal cancer. In this review, we summarize the presently available information on melatonin effects in the lower gut and discuss available in vitro and in vivo data. We furthermore aim to evaluate whether melatonin may be useful in future treatment of symptoms or diseases involving the lower gut.
文摘The diagnosis of gastrointestinal(GI) disorders is usually based on invasive techniques such as endoscopy.A key important factor in GI cancer is early diagnosis which warrants development of non-or lessinvasive diagnostic techniques.In addition,monitoring and surveillance are other important parts in the management of GI diseases.Metabolomics studies with nuclear magnetic resonance and mass spectrometry can measure the concentration of more than 3000 chemical compounds in the urine providing possible chemical signature in different diseases and during health.In this review,we discuss the urinary metabolomics signature of different GI diseases including GI cancer and elaborate on how these biomarkers could be used for the classification,early diagnosis and the monitoring of the patients.Moreover,we discuss future directions of this still evolving field of research.
基金The study was approved by the Texas Tech University Health Sciences Center Institutional Review Board(Approval Number.E14078).
文摘BACKGROUND Retrograde single balloon enteroscopy(SBE)is a minimally invasive procedure which is less frequently performed compared with antegrade SBE.There are few studies on the retrograde through-the-scope enteroscopy(TTSE),a novel technique for evaluation of the small bowel.AIM To compare the clinical utility and safety of retrograde TTSE with retrograde SBE.METHODS Clinical data and complications of retrograde TTSE(2014-2018)and retrograde SBE(2011-2018)performed in a community hospital were reviewed and presented as mean±SD or frequency(%)and compared using proper statistical tests.Technical success was defined as insertion of the enteroscope>20 cm beyond ileocecal valve.RESULTS Data obtained from 54 retrograde SBE in 49 patients and 27 retrograde TTSE in 26 patients were studied.The most common indication for retrograde enteroscopy was iron deficiency anemia(41 patients)followed by gastrointestinal bleeding(37 patients),and chronic diarrhea(7 patients).The duration of retrograde SBE procedure(91.9±34.2 min)was significantly longer compared with retrograde TTSE(70.5±30.7 min)(P=0.04).Technical success was comparable in TTSE[23/27(85.2%)]and SBE[41/54(75.9%)(P=0.33)].The mean depth of insertion beyond the ileocecal valve in retrograde SBE(92.5±70.0 cm)tended to be longer compared with retrograde TTSE(64.6±49.0 cm)(P=0.08).No complication was observed in this study.CONCLUSION Both retrograde TTSE and retrograde SBE are feasible and safe.Retrograde TTSE takes a shorter time and has a comparable technical success with SBE.TTSE has a lower capacity of small bowel insertion.
文摘BACKGROUND A recent expert panel issued recommendations about the technical aspects of direct endoscopic necrosectomy(DEN) for pancreatic walled-off necrosis(WON).However, significant technical heterogeneity still exists among endoscopists.AIM To report the outcomes of our DEN technique and how it differs from a recent expert consensus statement and previous studies.METHODS Medical records of patients with WON who underwent DEN from September2016-May 2019 were queried for the following information: Age, gender,ethnicity, etiology of acute pancreatitis, WON location and size, DEN technical information, adverse events(AEs) and outcomes. Adverse events were graded according to the American Society of Gastrointestinal Endoscopy Lexicon grading system. Technical success was defined as adequate lumen apposing metal stent(LAMS) deployment plus removal of ≥ 90% of necrosum. Clinical success was defined as complete resolution of WON cavity by imaging and resolution of symptoms at ≤ 3 months(mo) after last DEN. Data analysis was performed using mean and standard deviation for continuous variables,frequency and proportion for categorical variables, and median and range for interval data.RESULTS A total of 21 patients underwent DEN. Most of them were Hispanic and their mean age was 51 ± 17 years. The majority of the collections were located in the body of the pancreas and the mean size was 13 cm ± 5 cm. The most common indication was persistent vomiting. Antibiotics were administered only in cases of infected necrosis. All LAMS were placed without radiological guidance,dilated the same day of deployment and removed after a mean of 27 ± 11 d.Routine cross-sectional imaging immediately after drainage was not performed.The mean interval between DEN sessions was 7 ± 4 d and the mean number of DEN/patient was 3 ± 2. Technical and clinical success rates were both 95%. AEs were seen in 5 patients and included: Sepsis(2), stent migration(1), stent maldeployment(1), perforation(1). The sensitivity and positive predictive value of an occluded LAMS leading to sepsis was 50% and 0.11 respectively. No fatalities were observed.CONCLUSION Our DEN technique differed significantly from the one recommended by a recent expert panel and the one published in previous studies. Despite these differences excellent clinical outcomes were obtained.
