As an innovative endoscopic intervention,endoscopic ultrasound-guided pan-creatic duct drainage(EUS-PD)demonstrates significant clinical value in re-solving pancreatic ductal hypertension syndrome.By integrating real-...As an innovative endoscopic intervention,endoscopic ultrasound-guided pan-creatic duct drainage(EUS-PD)demonstrates significant clinical value in re-solving pancreatic ductal hypertension syndrome.By integrating real-time ultrasound guidance with catheter-based intervention techniques,this approach provides a safe and effective alternative for cases where conventional endoscopic retrograde cholangiopancreatography has failed.Current evidence indicates that EUS-PD achieves technical success rates ranging from 82%to 95%in alleviating symptomatic pancreatic duct hypertension caused by malignant obstructions and chronic pancreatitis-related strictures,with an overall complication rate(15%-20%)substantially lower than surgical interventions.Compared to conventional imaging modalities,EUS-PD offers superior anatomical visualization capabilities:Its high-frequency ultrasound probe enables precise identification of 3 mm-level pancreatic duct branches,while contrast-enhanced imaging significantly improves diagnostic accuracy in differentiating benign from malignant strictures(sensitivity 91%vs 73%,P<0.05).Nevertheless,technical challenges persist,including diffi-cult ductal puncture localization(particularly in pancreatic head lesions),complex guidewire axial control,and postoperative pancreatic fistula risks(7%-12%).This review systematically examines the clinical indications/contraindications,pro-cedural protocols,device selection criteria,and management strategies for early/late complications associated with EUS-PD.Special emphasis is placed on establishing anatomical pathway selection standards for transgastric-pancreatic duct vs transduodenal-pancreatic duct approaches.Advancements in auxiliary technologies(e.g.,three-dimensional elastography,AI-assisted navigation)and multidisciplinary team collab-oration are pivotal to developing standardized protocols.We propose establishing international multicenter registry databases and conducting prospective randomized controlled trials to clarify EUS-PD's position within pancreatic disease management systems.Such initiatives will facilitate the clinical transformation of EUS-PD from an"alternative option"to a"preferred strategy",ultimately enhancing treatment precision and improving clinical outcomes in pancreatic disorders.展开更多
Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult,including large(>20 mm)laterally spreading tumor...Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult,including large(>20 mm)laterally spreading tumors(LSTs),has increased in the last decade.All LSTs should be assessed carefully,looking for suspicious areas of submucosal invasion(SMI),such as nodules or depressed areas,describing the morphology according to the Paris classification,the pit pattern,and vascular pattern.The simplest,most appropriate and safest endoscopic treatment with curative intent should be selected.For LST-granular homogeneous type,piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI.LST-nongranular pseudodepressed type has an increased risk of SMI,and en bloc resection should be mandatory.Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field,e.g.,for the resection of scar lesions,with no lifting,adjacent tattoo,incomplete resection attempts,lesions into a colonic diverticulum,in ileocecal valve and lesions with intra-appendicular involvement.Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm.Among the indications,we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions.Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion.It should therefore be indicated in the treatment of lesions with risk of SMI.展开更多
As one of the basic processes of cellular activity,endocytosis sorting determines the fate of many proteins on the endosomal membranes,thus affecting a variety of important cellular processes,such as nutrient uptake,c...As one of the basic processes of cellular activity,endocytosis sorting determines the fate of many proteins on the endosomal membranes,thus affecting a variety of important cellular processes,such as nutrient uptake,cell signal transduction,intracellular ion homeostasis,etc.展开更多
The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has...The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has been suggested for ascertaining patient safety while positively influencing the trainees' learning curve. Virtual simulators are the most promising tool among all available types of simulators. These integrated modalities offer a human-like endoscopy experience by combining virtual images of the gastrointestinal tract and haptic realism with using a customized endoscope. From their first steps in the 1980s until today, research involving virtual endoscopic simulators can be divided in two categories: investigation of the impact of virtual simulator training in acquiring endoscopy skills and measuring competence. Emphasis should also be given to the financial impact of their implementation in endoscopy, including the cost of these state-of-theart simulators and the potential economic benefits from their usage. Advances in technology will contribute to the upgrade of existing models and the development of new ones; while further research should be carried out to discover new fields of application.展开更多
In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgical...In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically. Within each topic,the content will progress as follows: "lessons learned", "technical considerations"and "future opportunities". Lessons learned will provide a brief background and update on the most current literature. Technical considerations will include my personal experience, including tips and tricks that I have learned over the years.Finally, future opportunities will address current unmet needs and potential new areas of development. The foregut is defined as "the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver,pancreas, and part of the duodenum develop". Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease(GERD), achalasia, esophageal diverticula, Barrett's esophagus(BE) and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper. Regarding GERD, there are now several technologies available to effectively treat it and potentially eliminate symptoms, and the need for long-term treatment with proton pump inhibitors.For the first time, fundoplication can be performed without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing extended durability. In respect to achalasia, per-oral endoscopic myotomy(POEM) which was developed in Japan, has become an alternative to the traditional Heller's myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. There is now a resurgence of endoscopic treatment of Zenker's diverticula with improved technique(Z-POEM) and equipment; thus, patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. In regard to BE, endoscopic submucosal dissection(ESD)which is well established in Asia, is now becoming more mainstream in the West for the treatment of BE with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies(radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation), the entire spectrum of Barrett's and related dysplasia and early cancer can be managed predominantly by endoscopy.Importantly, in regard to early gastric cancer and submucosal tumors(SMTs) of the stomach, ESD and full thickness resection(FTR) can excise these lesions enbloc and endoscopic suturing is now used to close large defects and perforations.For treatment of patients with malignant gastric outlet obstruction(GOO),endoscopic gastro-jejunostomy is now showing better results than enteral stenting. G-POEM is also emerging as a treatment option for patients with gastroparesis. Obesity has become an epidemic in many western countries and is becoming also prevalent in Asia. Endoscopic sleeve gastroplasty(ESG) is now becoming an established treatment option, especially for obese patients with body mass index between 30 and 35. Data show an average weight loss of 16 kg after ESG with long-term data confirming sustainability. Finally, in respect to endo-hepatology, there are many new endoscopic interventions that have been developed for patients with liver disease. Endoscopic ultrasound(EUS)-guided liver biopsy and EUS-guided portal pressure measurement are exciting new frontiers for the endo-hepatologists.展开更多
The clinical outcome of patients receiving liver trans-plantation could be significantly affected by biliary complications, including strictures, leaks, stones and bilomas; early diagnosis and treatment of these con-d...The clinical outcome of patients receiving liver trans-plantation could be significantly affected by biliary complications, including strictures, leaks, stones and bilomas; early diagnosis and treatment of these con-ditions lead to markedly reduction in morbidity and mortality. Therapeutic gold standard is represented by conservative approaches, both endoscopic and percutaneous, based on the type of biliary reconstruction, the local availability of the procedures and specific expertise. In patients with previous transplantation, the difficult biliary access and the possible presence of concomitant complications(mainly strictures) further restrict the efficacy of the endoscopic and percutaneous treatments; on the other hand, surgery should generally be avoided because of the even increased morbidity and mortality due to technical and clinical issues. Here we review the most common biliary complications occurring after liver transplantation and discuss available treatment options including future perspectives such as endoscopic ultrasound-guided biliary access in patients with Roux-en-Y choledocho-jejunostomy or extracorporeal shock wave lithotripsy for difficult stones.展开更多
Since its introduction,endoscopic ultrasound(EUS)guided fine needle aspiration and fine needle biopsy have become an indispensable tool for the diagnosis of lesions within the gastrointestinal tract and surrounding or...Since its introduction,endoscopic ultrasound(EUS)guided fine needle aspiration and fine needle biopsy have become an indispensable tool for the diagnosis of lesions within the gastrointestinal tract and surrounding organs.It has proved to be an effective diagnostic method with high accuracy and low complication rates.Several factors can influence the accuracy and the diagnostic yield of this procedure including experience of the endosonographer,availability of onsite cytopathology services,the method of cytopathology preparation,the location and physical characteristics of the lesion,sampling techniques and the type and size of the needle used.In this review we will outline the recent studies evaluating EUS-guided tissue acquisition and will provide practical recommendations to maximize tissue yield.展开更多
In this paper, we define a group T_ρ(G) of p-endotrivial κG-modules and a generalized Dade group D_ρ(G) for a finite group G. We prove that T_ρ(G)≌T_ρ(H)whenever the subgroup H contains a normalizer of a Sylow p...In this paper, we define a group T_ρ(G) of p-endotrivial κG-modules and a generalized Dade group D_ρ(G) for a finite group G. We prove that T_ρ(G)≌T_ρ(H)whenever the subgroup H contains a normalizer of a Sylow p-subgroup of G, in this case, K(G)≌K(H). We also prove that the group D_ρ(G) can be embedded into T_ρ(G) as a subgroup.展开更多
Endoscopic submucosal dissection(ESD) has been invented in Japan to provide resection for cure of early cancer in the gastrointestinal tract. Professional level of ESD requires excellent staging of early neoplasias wi...Endoscopic submucosal dissection(ESD) has been invented in Japan to provide resection for cure of early cancer in the gastrointestinal tract. Professional level of ESD requires excellent staging of early neoplasias with image enhanced endoscopy(IEE) to make correct indications for ESD,and high skills in endoscopic electrosurgical dissection. In Japan,endodiagnostic and endosurgical excellence spread through personal tutoring of skilled endoscopists by the inventors and experts in IEE and ESD. To translocate this expertise to other continents must overcome two fundamental obstacles:(1) inadequate expectations as to the complexity of IEE and ESD; and(2) lack of suitable lesions and master-mentors for ESD trainees. Leading endoscopic mucosal resection-proficient endoscopists must pioneer themselves through the long learning curve to proficient ESD experts. Major referral centers for ESD must arise in Western countries on comparable professional level as in Japan. In the second stage,the upcoming Western experts must commit themselves to teach skilled endoscopists from other referral centers,in order to spread ESD in Western countries. Respect for patients with early gastrointestinal cancer asks for best efforts to learn endoscopic categorization of early neoplasias and skills for ESD based on sustained cooperation with the masters in Japan. The strategy is discussed here.展开更多
基金Supported by the Liaoning Provincial Science and Technology Plan Joint Program(Applied Basic Research Project),Undertaken by Shengjing Hospital of China Medical University in Collaboration with China Resources Health(Liaoning)Group Co.,Ltd.,No.2023JHZ/101700190.
文摘As an innovative endoscopic intervention,endoscopic ultrasound-guided pan-creatic duct drainage(EUS-PD)demonstrates significant clinical value in re-solving pancreatic ductal hypertension syndrome.By integrating real-time ultrasound guidance with catheter-based intervention techniques,this approach provides a safe and effective alternative for cases where conventional endoscopic retrograde cholangiopancreatography has failed.Current evidence indicates that EUS-PD achieves technical success rates ranging from 82%to 95%in alleviating symptomatic pancreatic duct hypertension caused by malignant obstructions and chronic pancreatitis-related strictures,with an overall complication rate(15%-20%)substantially lower than surgical interventions.Compared to conventional imaging modalities,EUS-PD offers superior anatomical visualization capabilities:Its high-frequency ultrasound probe enables precise identification of 3 mm-level pancreatic duct branches,while contrast-enhanced imaging significantly improves diagnostic accuracy in differentiating benign from malignant strictures(sensitivity 91%vs 73%,P<0.05).Nevertheless,technical challenges persist,including diffi-cult ductal puncture localization(particularly in pancreatic head lesions),complex guidewire axial control,and postoperative pancreatic fistula risks(7%-12%).This review systematically examines the clinical indications/contraindications,pro-cedural protocols,device selection criteria,and management strategies for early/late complications associated with EUS-PD.Special emphasis is placed on establishing anatomical pathway selection standards for transgastric-pancreatic duct vs transduodenal-pancreatic duct approaches.Advancements in auxiliary technologies(e.g.,three-dimensional elastography,AI-assisted navigation)and multidisciplinary team collab-oration are pivotal to developing standardized protocols.We propose establishing international multicenter registry databases and conducting prospective randomized controlled trials to clarify EUS-PD's position within pancreatic disease management systems.Such initiatives will facilitate the clinical transformation of EUS-PD from an"alternative option"to a"preferred strategy",ultimately enhancing treatment precision and improving clinical outcomes in pancreatic disorders.
文摘Due to the advent of the screening programs for colorectal cancer and the era of quality assurance colonoscopy the number the polyps that can be considered difficult,including large(>20 mm)laterally spreading tumors(LSTs),has increased in the last decade.All LSTs should be assessed carefully,looking for suspicious areas of submucosal invasion(SMI),such as nodules or depressed areas,describing the morphology according to the Paris classification,the pit pattern,and vascular pattern.The simplest,most appropriate and safest endoscopic treatment with curative intent should be selected.For LST-granular homogeneous type,piecemeal endoscopic mucosal resection should be the first option due to its biological low risk of SMI.LST-nongranular pseudodepressed type has an increased risk of SMI,and en bloc resection should be mandatory.Underwater endoscopic mucosal resection is useful in situations where submucosal injection alters the operative field,e.g.,for the resection of scar lesions,with no lifting,adjacent tattoo,incomplete resection attempts,lesions into a colonic diverticulum,in ileocecal valve and lesions with intra-appendicular involvement.Endoscopic full thickness resection is very useful for the treatment of difficult to resect lesions of less than 20 up to 25 mm.Among the indications,we highlight the treatment of polyps with suspected malignancy because the acquired tissue allows an exact histologic risk stratification to assign patients individually to the best treatment and avoid surgery for low-risk lesions.Endoscopic submucosal dissection is the only endoscopic procedure that allows completes en bloc resection regardless of the size of the lesion.It should therefore be indicated in the treatment of lesions with risk of SMI.
文摘As one of the basic processes of cellular activity,endocytosis sorting determines the fate of many proteins on the endosomal membranes,thus affecting a variety of important cellular processes,such as nutrient uptake,cell signal transduction,intracellular ion homeostasis,etc.
文摘The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has been suggested for ascertaining patient safety while positively influencing the trainees' learning curve. Virtual simulators are the most promising tool among all available types of simulators. These integrated modalities offer a human-like endoscopy experience by combining virtual images of the gastrointestinal tract and haptic realism with using a customized endoscope. From their first steps in the 1980s until today, research involving virtual endoscopic simulators can be divided in two categories: investigation of the impact of virtual simulator training in acquiring endoscopy skills and measuring competence. Emphasis should also be given to the financial impact of their implementation in endoscopy, including the cost of these state-of-theart simulators and the potential economic benefits from their usage. Advances in technology will contribute to the upgrade of existing models and the development of new ones; while further research should be carried out to discover new fields of application.
文摘In this paper, I reviewed the emerging field of endoscopic surgery and present data supporting the contention that endoscopy can now be used to treat many foregut diseases that have been traditionally treated surgically. Within each topic,the content will progress as follows: "lessons learned", "technical considerations"and "future opportunities". Lessons learned will provide a brief background and update on the most current literature. Technical considerations will include my personal experience, including tips and tricks that I have learned over the years.Finally, future opportunities will address current unmet needs and potential new areas of development. The foregut is defined as "the upper part of the embryonic alimentary canal from which the pharynx, esophagus, lung, stomach, liver,pancreas, and part of the duodenum develop". Foregut surgery is well established in treating conditions such as gastroesophageal reflux disease(GERD), achalasia, esophageal diverticula, Barrett's esophagus(BE) and esophageal cancer, stomach cancer, gastric-outlet obstruction, and obesity. Over the past decade, remarkable progress in interventional endoscopy has culminated in the conceptualization and practice of endoscopic foregut surgery for various clinical conditions summarized in this paper. Regarding GERD, there are now several technologies available to effectively treat it and potentially eliminate symptoms, and the need for long-term treatment with proton pump inhibitors.For the first time, fundoplication can be performed without the need for open or laparoscopic surgery. Long-term data going out 5-10 years are now emerging showing extended durability. In respect to achalasia, per-oral endoscopic myotomy(POEM) which was developed in Japan, has become an alternative to the traditional Heller's myotomy. Recent meta-analysis show that POEM may have better results than Heller, but the issue of post-POEM GERD still needs to be addressed. There is now a resurgence of endoscopic treatment of Zenker's diverticula with improved technique(Z-POEM) and equipment; thus, patients are choosing flexible endoscopic treatment as opposed to open or rigid endoscopy options. In regard to BE, endoscopic submucosal dissection(ESD)which is well established in Asia, is now becoming more mainstream in the West for the treatment of BE with high grade dysplasia, as well as early esophageal cancer. In combination with all the ablation technologies(radiofrequency ablation, cryotherapy, hybrid argon plasma coagulation), the entire spectrum of Barrett's and related dysplasia and early cancer can be managed predominantly by endoscopy.Importantly, in regard to early gastric cancer and submucosal tumors(SMTs) of the stomach, ESD and full thickness resection(FTR) can excise these lesions enbloc and endoscopic suturing is now used to close large defects and perforations.For treatment of patients with malignant gastric outlet obstruction(GOO),endoscopic gastro-jejunostomy is now showing better results than enteral stenting. G-POEM is also emerging as a treatment option for patients with gastroparesis. Obesity has become an epidemic in many western countries and is becoming also prevalent in Asia. Endoscopic sleeve gastroplasty(ESG) is now becoming an established treatment option, especially for obese patients with body mass index between 30 and 35. Data show an average weight loss of 16 kg after ESG with long-term data confirming sustainability. Finally, in respect to endo-hepatology, there are many new endoscopic interventions that have been developed for patients with liver disease. Endoscopic ultrasound(EUS)-guided liver biopsy and EUS-guided portal pressure measurement are exciting new frontiers for the endo-hepatologists.
文摘The clinical outcome of patients receiving liver trans-plantation could be significantly affected by biliary complications, including strictures, leaks, stones and bilomas; early diagnosis and treatment of these con-ditions lead to markedly reduction in morbidity and mortality. Therapeutic gold standard is represented by conservative approaches, both endoscopic and percutaneous, based on the type of biliary reconstruction, the local availability of the procedures and specific expertise. In patients with previous transplantation, the difficult biliary access and the possible presence of concomitant complications(mainly strictures) further restrict the efficacy of the endoscopic and percutaneous treatments; on the other hand, surgery should generally be avoided because of the even increased morbidity and mortality due to technical and clinical issues. Here we review the most common biliary complications occurring after liver transplantation and discuss available treatment options including future perspectives such as endoscopic ultrasound-guided biliary access in patients with Roux-en-Y choledocho-jejunostomy or extracorporeal shock wave lithotripsy for difficult stones.
文摘Since its introduction,endoscopic ultrasound(EUS)guided fine needle aspiration and fine needle biopsy have become an indispensable tool for the diagnosis of lesions within the gastrointestinal tract and surrounding organs.It has proved to be an effective diagnostic method with high accuracy and low complication rates.Several factors can influence the accuracy and the diagnostic yield of this procedure including experience of the endosonographer,availability of onsite cytopathology services,the method of cytopathology preparation,the location and physical characteristics of the lesion,sampling techniques and the type and size of the needle used.In this review we will outline the recent studies evaluating EUS-guided tissue acquisition and will provide practical recommendations to maximize tissue yield.
文摘In this paper, we define a group T_ρ(G) of p-endotrivial κG-modules and a generalized Dade group D_ρ(G) for a finite group G. We prove that T_ρ(G)≌T_ρ(H)whenever the subgroup H contains a normalizer of a Sylow p-subgroup of G, in this case, K(G)≌K(H). We also prove that the group D_ρ(G) can be embedded into T_ρ(G) as a subgroup.
基金Supported by Leonie-Wild Charitable Foundation,HeidelbergEppelheim
文摘Endoscopic submucosal dissection(ESD) has been invented in Japan to provide resection for cure of early cancer in the gastrointestinal tract. Professional level of ESD requires excellent staging of early neoplasias with image enhanced endoscopy(IEE) to make correct indications for ESD,and high skills in endoscopic electrosurgical dissection. In Japan,endodiagnostic and endosurgical excellence spread through personal tutoring of skilled endoscopists by the inventors and experts in IEE and ESD. To translocate this expertise to other continents must overcome two fundamental obstacles:(1) inadequate expectations as to the complexity of IEE and ESD; and(2) lack of suitable lesions and master-mentors for ESD trainees. Leading endoscopic mucosal resection-proficient endoscopists must pioneer themselves through the long learning curve to proficient ESD experts. Major referral centers for ESD must arise in Western countries on comparable professional level as in Japan. In the second stage,the upcoming Western experts must commit themselves to teach skilled endoscopists from other referral centers,in order to spread ESD in Western countries. Respect for patients with early gastrointestinal cancer asks for best efforts to learn endoscopic categorization of early neoplasias and skills for ESD based on sustained cooperation with the masters in Japan. The strategy is discussed here.
