Benign esophageal stricture is characterized by the narrowing of the digestivetract lumen due to multiple factors. Endoscopic treatment is the first treatmentchoice and includes endoscopic dilatation, drug injection, ...Benign esophageal stricture is characterized by the narrowing of the digestivetract lumen due to multiple factors. Endoscopic treatment is the first treatmentchoice and includes endoscopic dilatation, drug injection, stenosis incision, stentimplantation, stem cell flap transplantation, etc. However, there are currently nospecific clinical standards or guidelines to quantify a series of specific parametersin the treatment of benign esophageal stricture, such as the frequency of drugadministration, dosage, dilation inner diameter, and number of treatments. Thisleads to operator bias in clinical practice and inconsistent treatment outcomesamong patients. Therefore, this article reviews the current advances and existingchallenges in the endoscopic treatment of benign esophageal stricture, with theaim of exploring the possibility of achieving precision and standardization in theendoscopic treatment of this disease.展开更多
Esophageal stricture refers to a pathological narrowing of the esophageal lumen,causing dysphagia and impairing the patient's quality of life.There are various etiologies including esophageal malignancy,peptic inj...Esophageal stricture refers to a pathological narrowing of the esophageal lumen,causing dysphagia and impairing the patient's quality of life.There are various etiologies including esophageal malignancy,peptic injury,caustic ingestion,postsurgical anastomosis,radiation therapy,and inflammatory disorders such as eosinophilic esophagitis.The primary goal in managing esophageal strictures is to relieve dysphagia by maintaining luminal patency.Endoscopic dilation remains the mainstay of treatment for most benign strictures,with either bougie or balloon dilators.For patients who develop refractory or recurrent strictures that are difficult to manage with dilation alone,adjunctive therapies like intralesional steroid injections,topical or injected mitomycin C,incisional therapy,stent placement,and finally surgery may enhance outcomes and reduce the frequency of repeat procedures.The present review focuses on the basics of dilation and adjunctive strategies for the management of esophageal stricture.展开更多
BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval....BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval.Recurrent ES(REES)refer to the inability to maintain a satisfactory luminal diameter for four weeks once an ageappropriate feeding diameter was achieved.Seriated endoscopic dilations are the reference maintenance for ES in pediatric age.Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems.Furthermore,fibrotic modifications can make the surgery even more challenging.The surgical approach is burdened by high morbidity,with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.AIM To evaluate the efficacy and safety of the most recent adjuvant treatments,with the aim of avoiding or,at least,postponing surgery.METHODS Intralesional steroids or mitomycin C injections with antiproliferative and antifibroblastic properties have been attempted,but have been abandoned because of systemic adsorption,local complications,or lack of efficacy.Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications,in terms of stent migration,local pain and perforation.Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall,but it requires an appropriate diameter for placement.RESULTS Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space.Re-absorbable self-expanding stents(like SX-ELLA Stent Esophageal Degradable BD-BD stent)and energy-delivering surgical devices(HARMONIC ACE^(TM)+7 Laparoscope)have also been proposed.CONCLUSION After an overview about the historically applied adjuvant therapies,we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases,focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or,at least,postponing an invasive replacement surgery.展开更多
To the Editor:Living donor liver transplantation continues to be a widely ac-cepted treatment for end-stage liver diseases[1].However,biliary complications remain a significant challenge,attributable to both surgical ...To the Editor:Living donor liver transplantation continues to be a widely ac-cepted treatment for end-stage liver diseases[1].However,biliary complications remain a significant challenge,attributable to both surgical and nonsurgical factors.These complications include bile leakage,biliary stricture,and choledocholithiasis,with a reported incidence of biliary stricture in pediatric living donor liver recip-ients ranging from 10%to 35%[2].Commonly employed thera-peutic approaches for biliary complications are endoscopic retro-grade cholangiopancreatography(ERCP),percutaneous transhepatic cholangioscopic lithotomy(PTCSL),and surgery,with ERCP often being the preferred initial treatment.展开更多
BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who ex...BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.展开更多
Anastomotic stricture(AS)remains a significant complication following rectal anastomosis,with an incidence ranging from 5%to 30%depending on surgical technique,patient factors,and postoperative management.This review ...Anastomotic stricture(AS)remains a significant complication following rectal anastomosis,with an incidence ranging from 5%to 30%depending on surgical technique,patient factors,and postoperative management.This review aims to elucidate the pathophysiology of AS,exploring the underlying mechanisms that contribute to its development,including ischemia,inflammation,fibrosis,and impaired healing.Key risk factors such as low anterior resection,preoperative radiotherapy,and anastomotic leakage are critically analyzed based on recent clinical and experimental evidence.The article synthesizes current insights into the molecular and cellular processes,such as excessive collagen deposition and myofibroblast activation,that drive stricture formation.Furthermore,preventive strategies,including optimized surgical techniques(e.g.,tension-free anastomosis),enhanced perioperative care,and emerging therapeutic interventions(e.g.,anti-fibrotic agents),are discussed with an emphasis on translating research into clinical practice.By integrating findings from preclinical studies,clinical trials,and meta-analyses,this review highlights gaps in current knowledge and proposes future directions for research,such as the role of personalized medicine and novel biomaterials in reducing AS incidence.This comprehensive analysis underscores the need for a multidisciplinary approach to mitigate this challenging postoperative complication.展开更多
In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive ove...In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.展开更多
BACKGROUND Esophageal stricture is a prevalent condition affecting the digestive system,primarily marked by dysphagia and the obstruction of food passage through the esophagus.This narrowing of the esophageal lumen ca...BACKGROUND Esophageal stricture is a prevalent condition affecting the digestive system,primarily marked by dysphagia and the obstruction of food passage through the esophagus.This narrowing of the esophageal lumen can significantly impact a person’s ability to eat and drink comfortably,often leading to a decrease in nutritional intake and quality of life.AIM To explore the current research status and future trends of esophageal stricture through bibliometric analysis.METHODS Literature on esophageal stricture from 2004 to 2023 was retrieved from the Web of Science Core Collection.Statistical analysis was performed using Excel,VOSviewer,CiteSpace,and RStudio.This study provides data on annual production trends,countries/regions,influential authors,institutions,journals,references,and keywords.RESULTS The study included 1485 publications written by 7469 authors from 1692 institutions across 66 countries/regions,published in 417 journals.The United States,China,and Japan are the major contributors to this field,with many quality papers.Song Ho-young,Diseases of the Esophagus,Gastrointestinal Endoscopy,and Mayo Clinic are the top authors,journals,co-cited journals,and institutions,respectively.The most frequent keywords are stent,endoscopy,management,etiology,and prevention;regenerative medicine,endoscopic injection,and autologous tissue transplantation are the latest research frontiers.These keywords reflect continuous advancements in technical innovation,treatment strategies,preventive measures in the esophageal stricture research field,and a sustained focus on improving patient prognosis.In contrast,the basic sciences were underrepresented.CONCLUSION This study provides an insightful analysis of the developments in the field of esophageal stricture over the past twenty years,with stent placement is currently a hot research topic.展开更多
BACKGROUND Strictures in ulcerative colitis(UC)are relatively uncommon but are associated with increased risk of malignancy and complications.Until recently,fibrogenesis and strictures have remained largely unexplored...BACKGROUND Strictures in ulcerative colitis(UC)are relatively uncommon but are associated with increased risk of malignancy and complications.Until recently,fibrogenesis and strictures have remained largely unexplored in UC.AIM To investigate the incidence,long-term prognosis and risk factors of colorectal strictures in a large cohort of UC patients.METHODS A total of 938 hospitalized UC patients at Peking Union Medical College Hospital were included from 2014 to 2024.Stricture was defined as a fixed localized narrowing of the colorectal lumen.Risk factors for stricture formation were identified by multivariable Cox regression.Prognosis was analyzed using the Kaplan-Meier or Fine-Gray method.Sensitivity analysis excluded malignant strictures due to their distinct pathophysiology.RESULTS The overall incidence of stricture was 12.4%over a median follow-up of 8.70 years,with a 10-year cumulative probability of 11.3%.Malignancy occurred in 8.6%of stricture cases.UC patients with strictures were at higher risk for intestinal complications,surgery and malignancy(P<0.05).The 10-year cumulative probabilities of surgery and all-cause mortality were 37.6%and 1.6%,respectively.Age≥40 years at diagnosis[hazard ratio(HR)=2.197,95%confidence interval(CI):1.487-3.242]and extraintestinal manifestations(HR=2.072,95%CI:1.326-3.239)were associated with higher stricture risk,while the use of biological agents such as vedolizumab(HR=0.382,95%CI:0.203-0.720)was protective against strictures(P<0.05).Sensitivity analysis on benign strictures showed consistent findings,with similar risk factors and worse longterm outcomes.CONCLUSION UC patients with strictures had worse long-term prognostic outcomes.Earlier endoscopic surveillance and biologic treatment should be considered in patients≥40 years or those with extraintestinal manifestations.展开更多
BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stent...BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stents(MPSs)or fully covered self-expandable metal stents(cSEMSs)represent the standard treatment for BAS post-OLT.Recently,cSEMSs have emerged as the primary option for managing BAS post-OLT.AIM To compare the resolution and recurrence of BAS rates in these patients.METHODS This retrospective cohort study was conducted in a single tertiary care center(Hospital Israelita Albert Einstein,São Paulo,Brazil).We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022.Patients were stratified into two groups according to therapy:(1)MPSs;and(2)cSEMSs.Primary endpoints were to compare stricture resolution and recurrence among the groups.The secondary endpoint was to identify predictive factors for stricture recurrence.RESULTS A total of 104 patients were included.Overall stricture resolution was 101/104(97.1%).Stricture resolution was achieved in 83/84 patients(99%)in the cSEMS group and 18/20 patients(90%)in the MPS group(P=0.094).Failure occurred in 3/104 patients(2.8%).Stricture recurrence occurred in 9/104 patients(8.7%).Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups(P=0.201).A multivariate analysis identified the number of ERCP procedures(hazard ratio=1.4;95%confidence interval:1.194-1.619;P<0.001)and complications(hazard ratio=2.8;95%confidence interval:1.008-7.724;P=0.048)as predictors of stricture recurrence.CONCLUSION cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence.The number of ERCP procedures and complications were predictors of stricture recurrence.展开更多
Objective:The management of urethral stricture disease depends on the location,length of stricture,and associated urethral pathology.These parameters are obtained from preoperative imaging,with conventional urethrogra...Objective:The management of urethral stricture disease depends on the location,length of stricture,and associated urethral pathology.These parameters are obtained from preoperative imaging,with conventional urethrogram(retrograde urethrogram and micturating cystourethrogram[RGU/MCU])being the diagnostic tool of choice despite its many shortcomings.Sono-urethrogram(SUG)is an alternative that addresses most issues of RGU/MCU.Studies comparing RGU/MCU with SUG are limited.With the objective of comparing these two imaging modalities in the evaluation of urethral stricture disease,a prospective study was conducted.Methods:Fifty-six patients suspected of urethral stricture disease on clinical evaluation and confirmed either on RGU/MCU or urethro-cystoscopy were included in the study.SUG was performed by the experienced consultant radiologist who was blinded to the report of RGU/MCU.Findings of RGU/MCU and SUG were compared to intraoperative findings,which served as the reference standard.Results:The median length of the stricture determined intraoperatively was 16.5 mm,by RGU/MCU was 5.8 mm,and by SUG was 13.5 mm.The diagnostic accuracy for determination of the stricture location was 93%for RGU/MCU and 98%for SUG.SUG identified spongiofibrosis in 90%of patients with higher accuracy for the severe degree of spongiofibrosis.Conclusion:SUG has been shown to be more accurate than RGU/MCU in estimating stricture length(both short and intermediate)and localizing the stricture location.Use of SUG in conjunction with RGU/MCU helps in better guidance of stricture management by improving preoperative assessment.Further studies with larger sample sizes are warranted.展开更多
BACKGROUND Brush cytology is the most commonly used technique for tissue acquisition during endoscopic retrograde cholangiopancreatography for the evaluation of biliary strictures.Nonetheless,brush cytology is limited...BACKGROUND Brush cytology is the most commonly used technique for tissue acquisition during endoscopic retrograde cholangiopancreatography for the evaluation of biliary strictures.Nonetheless,brush cytology is limited by its low sensitivity due to insufficient cellular yield.AIM To evaluate the impact of the sheath-rinse technique on improving the cellularity yield.METHODS A total of 112 patients with suspected malignant biliary strictures were enrolled at two tertiary centers in South Korea.The sample cellularity and diagnostic accuracy of brush-wash and sheath-rinse specimens were compared.RESULTS A significantly increased number of total cell clusters per representative 20×field was recorded in the sheath-rinse compared with the brush-wash specimens(median:12 vs 3,P<0.001).This trend persisted when large(>50 cells)clusters(median:8 vs 3,P<0.001),medium(6-49 cells)(median:7 vs 3,P<0.001),and small(2-5 cells)clusters(median:9 vs 3,P<0.001)were evaluated.Diagnostic accuracy and sensitivity for differentiating malignancy were superior with sheath-rinsing than with the brush-wash method(72.3%vs 62.5%,P<0.001 and 69.9%vs 59.2%,P<0.001,respectively).CONCLUSION Incorporating sheath-rinse specimens significantly improved the yield and diagnostic accuracy of biliary brush cytology.Sheath-rinsing should be integrated into routine clinical practice to improve diagnostic performance for biliary strictures.展开更多
BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,an...BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,and with a significant risk of stricture recurrence.AIM To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.METHODS From 2012 to 2022,193 patients were treated at the A.V.Vishnevsky Surgical Center.All of them had different levels of strictures according to Bismuth-Strasberg classification:Type E1-2 in 32 patients,type E3-99,type E4-62.123 patients underwent open reconstructive interventions,70 percutaneous endobiliary interventions.RESULTS Long-term results were available for 192(99%)patients with a follow-up of 4.7±1.6 years after reconstructive surgery;3.0±1.4 years after percutaneous interventions.Excellent and good results(according to Terblanche classification)were achieved in 35%(42/122)of patients after open reconstructive surgery and in 13%(9/70)of patients after percutaneous transhepatic interventions(P-value<0.05).CONCLUSION Technically,the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5.The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.展开更多
Objective:To present the surgical technique of robotic buccal ureteroplasty for strictures after laser lithotripsy and its outcomes.Methods:This was a retrospective study conducted at the Department of Urology,Apollo ...Objective:To present the surgical technique of robotic buccal ureteroplasty for strictures after laser lithotripsy and its outcomes.Methods:This was a retrospective study conducted at the Department of Urology,Apollo Hospitals,Chennai,India from October 2012 to October 2022.Indications for surgery included worsening hydronephrosis,declining renal function,and recurrent urinary tract infections with obstruction.Apart from liberal exposure of the stricture,we stress upon use of indocyanine green to assess vascularity and quilting of the graft to bare area of the psoas muscle to increase graft vascularity.Results:Among the 15 patients,ureteropelvic junction strictures were observed in eight(53%),while five(33%)had proximal ureteric strictures,and two(13%)had mid-ureteral strictures.Notably,eight of the 15 patients(53%)had previous unsuccessful double-J stenting.The median stricture length was 3.5(range:2.0–5.0)cm,with a mean operative time of 167(range:126–214)min and estimated blood loss of 60(range:40–100)mL.After a median follow-up of 12(range:4–32)months,13 out of the 15 patients(87%)showed significant improvement in their follow-up functional scans.Conclusion:Robotic buccal ureteroplasty is a very effective technique for the management of laser-induced ureteral strictures with good long-term results and minimal morbidity.The results are comparable irrespective of previous failed stenting.展开更多
Endoscopic submucosal dissection(ESD)is an effective technique for treating early esophageal cancer,and the prevention of postoperative esophageal stricture has emerged as a significant research topic.Zhou et al utili...Endoscopic submucosal dissection(ESD)is an effective technique for treating early esophageal cancer,and the prevention of postoperative esophageal stricture has emerged as a significant research topic.Zhou et al utilized an experimental minipig model to demonstrate that Kangfuxin(KFX)can improve postoperative esophageal stricture following ESD by inhibiting transforming growth factor-β1-driven fibrosis and the downstream fibrotic mediators Smad2/3.In this letter,we primarily discuss recent advancements in the treatment of esophageal stricture,the clinical applications of KFX,and the mechanisms involved in alleviating postoperative esophageal stricture,aiming to provide insights for advancing clinical practice and research in esophageal stricture after ESD.展开更多
Biliary strictures are caused by both benign and malignant pathologies.Although up to 30%of biliary strictures are identified as benign,the vast majority are malignant with two major malignancies,namely pancreatic ade...Biliary strictures are caused by both benign and malignant pathologies.Although up to 30%of biliary strictures are identified as benign,the vast majority are malignant with two major malignancies,namely pancreatic adenocarcinoma and cholangiocarcinoma(CC)[1].Accurate diagnosis and precise localization play a vital role in the prognosis and management of the disease[2].In this study we primarily focused on the diagnosis of CC.The highest incidence of CC is in northeastern Thailand,where the incidence is found to be 100/100000 in males and 50/100000 in females.In Western countries,it is approximately(0.5–2.0)/100000 individuals[3].CC is most often diagnosed between the ages of 70 and 80 years[4].The prognosis of biliary malignancies is dismal with overall five-year survival as low as 10%[5].展开更多
BACKGROUND The role of NLR family pyrin domain containing 3(NLRP3)in post-endoscopic submucosal dissection(ESD)esophageal stricture remains incompletely understood.The effect of celastrol(CEL)on the prevention of esop...BACKGROUND The role of NLR family pyrin domain containing 3(NLRP3)in post-endoscopic submucosal dissection(ESD)esophageal stricture remains incompletely understood.The effect of celastrol(CEL)on the prevention of esophageal strictures has not yet been investigated.AIM To explore the effect of CEL on the prevention of esophageal stricture in rats.METHODS NLRP3,interleukin(IL)-1β,and IL-18 mRNA levels were measured in patients’tissues after esophageal ESD.NLRP3 expression in esophageal fibroblasts was determined using immunohistochemistry and immunofluorescence staining.Lentiviral transfection was used to induce NLRP3 overexpression and thioredoxin reductase 1(TXNRD1)silencing.The CCK8 assay was used to determine the optimal CEL concentration.Reactive oxygen species(ROS)generation was detected via fluorescence and flow cytometry.Masson’s trichrome staining and barium esophagography were performed to assess collagen deposition and esophageal stenosis.RESULTS The mRNA levels of NLRP3 and IL-1βwere higher in human tissues from the ESD resection bed than in normal esophageal mucosa.NLRP3 overexpression in primary rat esophageal fibroblasts led to high collagen 1 expression.Thus,NLRP3 participated in esophageal inflammation and tissue repair after ESD.Comparable to prednisolone,CEL significantly inhibited NLRP3 activation in vitro and in vivo,and esophageal strictures were markedly alleviated.Mechanistically,CEL upregulated TXNRD1 expression and reduced ROS production,thereby inhibiting NLRP3 expression.This effect was reversed by TXNRD1 silencing.Furthermore,TXNRD1 interacted with NLRP3 and promoted its ubiquitination.CONCLUSION CEL is a promising alternative therapeutic agent for the prevention of post-ESD esophageal strictures.展开更多
BACKGROUND Endoscopic ultrasound(EUS)has evolved from a diagnostic tool to a management technique for various gastroenterological conditions,including biliary strictures.AIM To summarize the current evidence on EUS’s...BACKGROUND Endoscopic ultrasound(EUS)has evolved from a diagnostic tool to a management technique for various gastroenterological conditions,including biliary strictures.AIM To summarize the current evidence on EUS’s role in diagnosing and managing biliary strictures.METHODS Two independent reviewers searched five electronic databases(PubMed,CENTRAL,Science Direct,Google Scholar,and EMBASE)for articles published up to January 2025.Included articles met specific criteria,and statistical software was used to analyze reported outcomes.RESULTS Of 935 articles,19 met the inclusion criteria.Ten articles focused on diagnostic EUS,while nine focused on EUSguided therapeutic interventions.EUS fine-needle aspiration demonstrated superior sensitivity[0.43-1.00;95%confidence interval(CI):0.24-1.00]compared to conventional techniques(0.36-0.96;95%CI:0.19-0.99)for diagnosing malignant biliary strictures.Both EUS-fine-needle aspiration and conventional methods exhibited high specificity,with most achieving 100%specificity.EUS-guided interventions showed significantly higher clinical success rates than control interventions(odds ratio=2.89;95%CI:1.22-6.84;P=0.02).No significant difference was observed in technical success rates(odds ratio=0.97;95%CI:0.30-3.16;P=0.96).CONCLUSION EUS is a promising tool for diagnosing and managing biliary strictures.Combining EUS-guided and conventional interventions improves diagnostic performance.Further research is needed to investigate the feasibility and use of EUS-guided interventions in this field.展开更多
Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pa...Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pathology.A positive histological diagnosis is always preferred prior to high risk hepatobiliary surgery,or to inform other types of therapy.Endoscopic retrograde cholangiopancreato-graphy with brushings has low sensitivity and despite significant improvements in instruments there is still an unacceptably high false negative rate.Other methods such as endoscopic ultrasound and cholangioscopy have improved diagnostic quality.In this review we explore the techniques available to aid accurate diagnosis of indeterminate biliary strictures and obtain accurate histology to facilitate clinical management.展开更多
Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Bil...Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Biliary strictures following LT are divided into anastomotic strictures (AS) and non-anastomotic strictures (NAS). A Limitation of current published researches is that most studies aren’t based on clinical practice. The aim of this review is to summarize risk factors, clinical presentation, diagnosis and management in post-LT biliary strictures.展开更多
文摘Benign esophageal stricture is characterized by the narrowing of the digestivetract lumen due to multiple factors. Endoscopic treatment is the first treatmentchoice and includes endoscopic dilatation, drug injection, stenosis incision, stentimplantation, stem cell flap transplantation, etc. However, there are currently nospecific clinical standards or guidelines to quantify a series of specific parametersin the treatment of benign esophageal stricture, such as the frequency of drugadministration, dosage, dilation inner diameter, and number of treatments. Thisleads to operator bias in clinical practice and inconsistent treatment outcomesamong patients. Therefore, this article reviews the current advances and existingchallenges in the endoscopic treatment of benign esophageal stricture, with theaim of exploring the possibility of achieving precision and standardization in theendoscopic treatment of this disease.
文摘Esophageal stricture refers to a pathological narrowing of the esophageal lumen,causing dysphagia and impairing the patient's quality of life.There are various etiologies including esophageal malignancy,peptic injury,caustic ingestion,postsurgical anastomosis,radiation therapy,and inflammatory disorders such as eosinophilic esophagitis.The primary goal in managing esophageal strictures is to relieve dysphagia by maintaining luminal patency.Endoscopic dilation remains the mainstay of treatment for most benign strictures,with either bougie or balloon dilators.For patients who develop refractory or recurrent strictures that are difficult to manage with dilation alone,adjunctive therapies like intralesional steroid injections,topical or injected mitomycin C,incisional therapy,stent placement,and finally surgery may enhance outcomes and reduce the frequency of repeat procedures.The present review focuses on the basics of dilation and adjunctive strategies for the management of esophageal stricture.
文摘BACKGROUND Refractory esophageal strictures(ES)are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval.Recurrent ES(REES)refer to the inability to maintain a satisfactory luminal diameter for four weeks once an ageappropriate feeding diameter was achieved.Seriated endoscopic dilations are the reference maintenance for ES in pediatric age.Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems.Furthermore,fibrotic modifications can make the surgery even more challenging.The surgical approach is burdened by high morbidity,with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.AIM To evaluate the efficacy and safety of the most recent adjuvant treatments,with the aim of avoiding or,at least,postponing surgery.METHODS Intralesional steroids or mitomycin C injections with antiproliferative and antifibroblastic properties have been attempted,but have been abandoned because of systemic adsorption,local complications,or lack of efficacy.Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications,in terms of stent migration,local pain and perforation.Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall,but it requires an appropriate diameter for placement.RESULTS Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space.Re-absorbable self-expanding stents(like SX-ELLA Stent Esophageal Degradable BD-BD stent)and energy-delivering surgical devices(HARMONIC ACE^(TM)+7 Laparoscope)have also been proposed.CONCLUSION After an overview about the historically applied adjuvant therapies,we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases,focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or,at least,postponing an invasive replacement surgery.
文摘To the Editor:Living donor liver transplantation continues to be a widely ac-cepted treatment for end-stage liver diseases[1].However,biliary complications remain a significant challenge,attributable to both surgical and nonsurgical factors.These complications include bile leakage,biliary stricture,and choledocholithiasis,with a reported incidence of biliary stricture in pediatric living donor liver recip-ients ranging from 10%to 35%[2].Commonly employed thera-peutic approaches for biliary complications are endoscopic retro-grade cholangiopancreatography(ERCP),percutaneous transhepatic cholangioscopic lithotomy(PTCSL),and surgery,with ERCP often being the preferred initial treatment.
文摘BACKGROUND Proximal bile duct injury(BDI),which often occurs after laparoscopic cholecystectomy(LC),can lead to complex biliary stricture and recurrent cholangitis.This case report presented a 39-year-old woman who experienced proximal BDI during LC in 2017,leading to multiple episodes of cholangitis and subsequent hepaticojejunostomy in 2018.Despite these interventions,persistent biliary complications necessitated repeated hospital admissions and antibiotic treatment.Imaging studies revealed persistent stricture at the site of hepaticojejunostomy,prompting a series of percutaneous procedures,including balloon dilatation and biliary drainage.In August 2024,she underwent biodegradable biliary stenting,which significantly improved her condition.Subsequently,she remained clinically stable for 5 months without further episodes of cholangitis and had improved liver function tests.This case highlighted the complexities of managing postinjury biliary stricture,underscored the potential of biodegradable stents as an effective treatment option,and emphasized the need for a multidisciplinary approach in managing such complications.Long-term follow-up is essential for monitoring treatment effectiveness and preventing recurrence.CASE SUMMARY A 39-year-old female had a routine LC in 2017.The patient sustained a proximal BDI during the surgery.In the months that followed,recurrent bouts of cholangitis occurred.A hepaticojejunostomy biliary reconstruction was performed in 2018.However,hepatic cholangitis persisted.In 2021 and 2022,MRCP scans revealed biliary stasis,duct dilation,and a stricture at the hepaticojejunostomy site.A subsequent percutaneous transhepatic cholangiography(PTC)confirmed these findings and led to drain placement.The treatment included internal and external biliary drain placements,repeated balloon dilations of the stricture,percutaneous transhepatic cholangioscopy to extract intrahepatic lithiasis,and insertion of a biodegradable biliary stent.Since the first PTC intervention,there have been no hospital admissions for cholangitis.Liver function tests showed improvement,and for five months following the biodegradable stenting,the condition remained stable.Long-term surveillance with regular imaging and blood work has been emphasized.The final diagnosis is recurrent biliary stricture secondary to proximal BDI.Treatment,including hepaticojejunostomy,repeated PTC with balloon dilation,and biodegradable biliary stenting,has led to complete drainage of the biliary system.Ongoing follow-up remains crucial for monitoring the patient's progress and maintaining their health.CONCLUSION This case demonstrated how strictures and recurrent cholangitis complicate the management of BDI after LC.A customized and multidisciplinary approach to control chronic biliary disease was proven effective,as shown by the patient’s good outcome.This was achieved by integrating balloon dilatation sessions,biliary drainage,stone clearing,and biodegradable stent placement.Long-term follow-up and continued monitoring remain essential to ensure patient stability and prevent further complications.
文摘Anastomotic stricture(AS)remains a significant complication following rectal anastomosis,with an incidence ranging from 5%to 30%depending on surgical technique,patient factors,and postoperative management.This review aims to elucidate the pathophysiology of AS,exploring the underlying mechanisms that contribute to its development,including ischemia,inflammation,fibrosis,and impaired healing.Key risk factors such as low anterior resection,preoperative radiotherapy,and anastomotic leakage are critically analyzed based on recent clinical and experimental evidence.The article synthesizes current insights into the molecular and cellular processes,such as excessive collagen deposition and myofibroblast activation,that drive stricture formation.Furthermore,preventive strategies,including optimized surgical techniques(e.g.,tension-free anastomosis),enhanced perioperative care,and emerging therapeutic interventions(e.g.,anti-fibrotic agents),are discussed with an emphasis on translating research into clinical practice.By integrating findings from preclinical studies,clinical trials,and meta-analyses,this review highlights gaps in current knowledge and proposes future directions for research,such as the role of personalized medicine and novel biomaterials in reducing AS incidence.This comprehensive analysis underscores the need for a multidisciplinary approach to mitigate this challenging postoperative complication.
文摘In this editorial,we explored currently available strategies for reducing the occurrence of esophageal strictures following circumferential endoscopic submucosal dissection.This manuscript provided a comprehensive overview of the various strategies including recent insights from Wang et al.To this end,stenosis-related symptoms such as dysphagia and vomiting can severely affect a patient’s quality of life.Therefore,we assess the efficacy of both reactive and proactive measures,ranging from traditional approaches like endoscopic balloon dilation and steroid administration to more advanced techniques,including tissue engineering and polyglycolic acid sheet placement.However,no single treatment has shown high efficacy,particularly for resections involving the entire circumference.Despite these shortcomings,the combination of different strategies may improve patient outcomes,although further large-scale studies are needed for validation.
基金Supported by Beijing Science and Technology Planning Project,No.Z221100007422061the Natural Science Foundation of Shaanxi Province,General Project,No.2018SF-159.
文摘BACKGROUND Esophageal stricture is a prevalent condition affecting the digestive system,primarily marked by dysphagia and the obstruction of food passage through the esophagus.This narrowing of the esophageal lumen can significantly impact a person’s ability to eat and drink comfortably,often leading to a decrease in nutritional intake and quality of life.AIM To explore the current research status and future trends of esophageal stricture through bibliometric analysis.METHODS Literature on esophageal stricture from 2004 to 2023 was retrieved from the Web of Science Core Collection.Statistical analysis was performed using Excel,VOSviewer,CiteSpace,and RStudio.This study provides data on annual production trends,countries/regions,influential authors,institutions,journals,references,and keywords.RESULTS The study included 1485 publications written by 7469 authors from 1692 institutions across 66 countries/regions,published in 417 journals.The United States,China,and Japan are the major contributors to this field,with many quality papers.Song Ho-young,Diseases of the Esophagus,Gastrointestinal Endoscopy,and Mayo Clinic are the top authors,journals,co-cited journals,and institutions,respectively.The most frequent keywords are stent,endoscopy,management,etiology,and prevention;regenerative medicine,endoscopic injection,and autologous tissue transplantation are the latest research frontiers.These keywords reflect continuous advancements in technical innovation,treatment strategies,preventive measures in the esophageal stricture research field,and a sustained focus on improving patient prognosis.In contrast,the basic sciences were underrepresented.CONCLUSION This study provides an insightful analysis of the developments in the field of esophageal stricture over the past twenty years,with stent placement is currently a hot research topic.
基金Supported by the National Natural Science Foundation of China,No.82270567the Central High-Level Hospital Clinical Research Project of Peking Union Medical College Hospital,No.2022-PUMCH-B-022 and No.2022-PUMCH-C-055.
文摘BACKGROUND Strictures in ulcerative colitis(UC)are relatively uncommon but are associated with increased risk of malignancy and complications.Until recently,fibrogenesis and strictures have remained largely unexplored in UC.AIM To investigate the incidence,long-term prognosis and risk factors of colorectal strictures in a large cohort of UC patients.METHODS A total of 938 hospitalized UC patients at Peking Union Medical College Hospital were included from 2014 to 2024.Stricture was defined as a fixed localized narrowing of the colorectal lumen.Risk factors for stricture formation were identified by multivariable Cox regression.Prognosis was analyzed using the Kaplan-Meier or Fine-Gray method.Sensitivity analysis excluded malignant strictures due to their distinct pathophysiology.RESULTS The overall incidence of stricture was 12.4%over a median follow-up of 8.70 years,with a 10-year cumulative probability of 11.3%.Malignancy occurred in 8.6%of stricture cases.UC patients with strictures were at higher risk for intestinal complications,surgery and malignancy(P<0.05).The 10-year cumulative probabilities of surgery and all-cause mortality were 37.6%and 1.6%,respectively.Age≥40 years at diagnosis[hazard ratio(HR)=2.197,95%confidence interval(CI):1.487-3.242]and extraintestinal manifestations(HR=2.072,95%CI:1.326-3.239)were associated with higher stricture risk,while the use of biological agents such as vedolizumab(HR=0.382,95%CI:0.203-0.720)was protective against strictures(P<0.05).Sensitivity analysis on benign strictures showed consistent findings,with similar risk factors and worse longterm outcomes.CONCLUSION UC patients with strictures had worse long-term prognostic outcomes.Earlier endoscopic surveillance and biologic treatment should be considered in patients≥40 years or those with extraintestinal manifestations.
文摘BACKGROUND Biliary anastomotic stricture(BAS)occurs in approximately 14%-20%of patients post-orthotopic liver transplantation(post-OLT).Endoscopic retrograde cholan-giopancreatography(ERCP)using multiple plastic stents(MPSs)or fully covered self-expandable metal stents(cSEMSs)represent the standard treatment for BAS post-OLT.Recently,cSEMSs have emerged as the primary option for managing BAS post-OLT.AIM To compare the resolution and recurrence of BAS rates in these patients.METHODS This retrospective cohort study was conducted in a single tertiary care center(Hospital Israelita Albert Einstein,São Paulo,Brazil).We reported the results of endoscopic therapy in patients with post-OLT BAS between 2012 and 2022.Patients were stratified into two groups according to therapy:(1)MPSs;and(2)cSEMSs.Primary endpoints were to compare stricture resolution and recurrence among the groups.The secondary endpoint was to identify predictive factors for stricture recurrence.RESULTS A total of 104 patients were included.Overall stricture resolution was 101/104(97.1%).Stricture resolution was achieved in 83/84 patients(99%)in the cSEMS group and 18/20 patients(90%)in the MPS group(P=0.094).Failure occurred in 3/104 patients(2.8%).Stricture recurrence occurred in 9/104 patients(8.7%).Kaplan-Meier analysis showed there was no difference in recurrence-free time among the groups(P=0.201).A multivariate analysis identified the number of ERCP procedures(hazard ratio=1.4;95%confidence interval:1.194-1.619;P<0.001)and complications(hazard ratio=2.8;95%confidence interval:1.008-7.724;P=0.048)as predictors of stricture recurrence.CONCLUSION cSEMSs and MPSs were effective and comparable regarding BAS post-OLT resolution and recurrence.The number of ERCP procedures and complications were predictors of stricture recurrence.
文摘Objective:The management of urethral stricture disease depends on the location,length of stricture,and associated urethral pathology.These parameters are obtained from preoperative imaging,with conventional urethrogram(retrograde urethrogram and micturating cystourethrogram[RGU/MCU])being the diagnostic tool of choice despite its many shortcomings.Sono-urethrogram(SUG)is an alternative that addresses most issues of RGU/MCU.Studies comparing RGU/MCU with SUG are limited.With the objective of comparing these two imaging modalities in the evaluation of urethral stricture disease,a prospective study was conducted.Methods:Fifty-six patients suspected of urethral stricture disease on clinical evaluation and confirmed either on RGU/MCU or urethro-cystoscopy were included in the study.SUG was performed by the experienced consultant radiologist who was blinded to the report of RGU/MCU.Findings of RGU/MCU and SUG were compared to intraoperative findings,which served as the reference standard.Results:The median length of the stricture determined intraoperatively was 16.5 mm,by RGU/MCU was 5.8 mm,and by SUG was 13.5 mm.The diagnostic accuracy for determination of the stricture location was 93%for RGU/MCU and 98%for SUG.SUG identified spongiofibrosis in 90%of patients with higher accuracy for the severe degree of spongiofibrosis.Conclusion:SUG has been shown to be more accurate than RGU/MCU in estimating stricture length(both short and intermediate)and localizing the stricture location.Use of SUG in conjunction with RGU/MCU helps in better guidance of stricture management by improving preoperative assessment.Further studies with larger sample sizes are warranted.
基金Supported by The Catholic Medical Center Research Foundation Made in The Program Year of 2022.
文摘BACKGROUND Brush cytology is the most commonly used technique for tissue acquisition during endoscopic retrograde cholangiopancreatography for the evaluation of biliary strictures.Nonetheless,brush cytology is limited by its low sensitivity due to insufficient cellular yield.AIM To evaluate the impact of the sheath-rinse technique on improving the cellularity yield.METHODS A total of 112 patients with suspected malignant biliary strictures were enrolled at two tertiary centers in South Korea.The sample cellularity and diagnostic accuracy of brush-wash and sheath-rinse specimens were compared.RESULTS A significantly increased number of total cell clusters per representative 20×field was recorded in the sheath-rinse compared with the brush-wash specimens(median:12 vs 3,P<0.001).This trend persisted when large(>50 cells)clusters(median:8 vs 3,P<0.001),medium(6-49 cells)(median:7 vs 3,P<0.001),and small(2-5 cells)clusters(median:9 vs 3,P<0.001)were evaluated.Diagnostic accuracy and sensitivity for differentiating malignancy were superior with sheath-rinsing than with the brush-wash method(72.3%vs 62.5%,P<0.001 and 69.9%vs 59.2%,P<0.001,respectively).CONCLUSION Incorporating sheath-rinse specimens significantly improved the yield and diagnostic accuracy of biliary brush cytology.Sheath-rinsing should be integrated into routine clinical practice to improve diagnostic performance for biliary strictures.
文摘BACKGROUND It is well known that in case of high initial strictures of bile ducts surgical treatment is associated with a high risk of damage to the hepatoduodenal ligament elements,often involved in rough scarring,and with a significant risk of stricture recurrence.AIM To compare the long-term outcomes of different surgical treatment options for patients with high-grade benign biliary strictures.METHODS From 2012 to 2022,193 patients were treated at the A.V.Vishnevsky Surgical Center.All of them had different levels of strictures according to Bismuth-Strasberg classification:Type E1-2 in 32 patients,type E3-99,type E4-62.123 patients underwent open reconstructive interventions,70 percutaneous endobiliary interventions.RESULTS Long-term results were available for 192(99%)patients with a follow-up of 4.7±1.6 years after reconstructive surgery;3.0±1.4 years after percutaneous interventions.Excellent and good results(according to Terblanche classification)were achieved in 35%(42/122)of patients after open reconstructive surgery and in 13%(9/70)of patients after percutaneous transhepatic interventions(P-value<0.05).CONCLUSION Technically,the most difficult bile duct strictures for reconstructive and percutaneous transhepatic interventions with a high recurrence rate are Bismuth-Strasberg type E4 and E5.The comparative analysis of long-term results of percutaneous and open procedures showed a statistically significant advantage of percutaneous procedures compared to open reconstructive procedures.
文摘Objective:To present the surgical technique of robotic buccal ureteroplasty for strictures after laser lithotripsy and its outcomes.Methods:This was a retrospective study conducted at the Department of Urology,Apollo Hospitals,Chennai,India from October 2012 to October 2022.Indications for surgery included worsening hydronephrosis,declining renal function,and recurrent urinary tract infections with obstruction.Apart from liberal exposure of the stricture,we stress upon use of indocyanine green to assess vascularity and quilting of the graft to bare area of the psoas muscle to increase graft vascularity.Results:Among the 15 patients,ureteropelvic junction strictures were observed in eight(53%),while five(33%)had proximal ureteric strictures,and two(13%)had mid-ureteral strictures.Notably,eight of the 15 patients(53%)had previous unsuccessful double-J stenting.The median stricture length was 3.5(range:2.0–5.0)cm,with a mean operative time of 167(range:126–214)min and estimated blood loss of 60(range:40–100)mL.After a median follow-up of 12(range:4–32)months,13 out of the 15 patients(87%)showed significant improvement in their follow-up functional scans.Conclusion:Robotic buccal ureteroplasty is a very effective technique for the management of laser-induced ureteral strictures with good long-term results and minimal morbidity.The results are comparable irrespective of previous failed stenting.
基金Supported by National Natural Science Foundation of China,No.82370715,No.32270768,and No.82273970National Key R and D Program of China,No.2023YFC2507904Innovation Group Project of Hubei Province,No.2023AFA026.
文摘Endoscopic submucosal dissection(ESD)is an effective technique for treating early esophageal cancer,and the prevention of postoperative esophageal stricture has emerged as a significant research topic.Zhou et al utilized an experimental minipig model to demonstrate that Kangfuxin(KFX)can improve postoperative esophageal stricture following ESD by inhibiting transforming growth factor-β1-driven fibrosis and the downstream fibrotic mediators Smad2/3.In this letter,we primarily discuss recent advancements in the treatment of esophageal stricture,the clinical applications of KFX,and the mechanisms involved in alleviating postoperative esophageal stricture,aiming to provide insights for advancing clinical practice and research in esophageal stricture after ESD.
基金supported by a grant from MH CZ–DRO(FNOl,00098892)。
文摘Biliary strictures are caused by both benign and malignant pathologies.Although up to 30%of biliary strictures are identified as benign,the vast majority are malignant with two major malignancies,namely pancreatic adenocarcinoma and cholangiocarcinoma(CC)[1].Accurate diagnosis and precise localization play a vital role in the prognosis and management of the disease[2].In this study we primarily focused on the diagnosis of CC.The highest incidence of CC is in northeastern Thailand,where the incidence is found to be 100/100000 in males and 50/100000 in females.In Western countries,it is approximately(0.5–2.0)/100000 individuals[3].CC is most often diagnosed between the ages of 70 and 80 years[4].The prognosis of biliary malignancies is dismal with overall five-year survival as low as 10%[5].
基金Supported by National Natural Science Foundation of China,No.82002609.
文摘BACKGROUND The role of NLR family pyrin domain containing 3(NLRP3)in post-endoscopic submucosal dissection(ESD)esophageal stricture remains incompletely understood.The effect of celastrol(CEL)on the prevention of esophageal strictures has not yet been investigated.AIM To explore the effect of CEL on the prevention of esophageal stricture in rats.METHODS NLRP3,interleukin(IL)-1β,and IL-18 mRNA levels were measured in patients’tissues after esophageal ESD.NLRP3 expression in esophageal fibroblasts was determined using immunohistochemistry and immunofluorescence staining.Lentiviral transfection was used to induce NLRP3 overexpression and thioredoxin reductase 1(TXNRD1)silencing.The CCK8 assay was used to determine the optimal CEL concentration.Reactive oxygen species(ROS)generation was detected via fluorescence and flow cytometry.Masson’s trichrome staining and barium esophagography were performed to assess collagen deposition and esophageal stenosis.RESULTS The mRNA levels of NLRP3 and IL-1βwere higher in human tissues from the ESD resection bed than in normal esophageal mucosa.NLRP3 overexpression in primary rat esophageal fibroblasts led to high collagen 1 expression.Thus,NLRP3 participated in esophageal inflammation and tissue repair after ESD.Comparable to prednisolone,CEL significantly inhibited NLRP3 activation in vitro and in vivo,and esophageal strictures were markedly alleviated.Mechanistically,CEL upregulated TXNRD1 expression and reduced ROS production,thereby inhibiting NLRP3 expression.This effect was reversed by TXNRD1 silencing.Furthermore,TXNRD1 interacted with NLRP3 and promoted its ubiquitination.CONCLUSION CEL is a promising alternative therapeutic agent for the prevention of post-ESD esophageal strictures.
文摘BACKGROUND Endoscopic ultrasound(EUS)has evolved from a diagnostic tool to a management technique for various gastroenterological conditions,including biliary strictures.AIM To summarize the current evidence on EUS’s role in diagnosing and managing biliary strictures.METHODS Two independent reviewers searched five electronic databases(PubMed,CENTRAL,Science Direct,Google Scholar,and EMBASE)for articles published up to January 2025.Included articles met specific criteria,and statistical software was used to analyze reported outcomes.RESULTS Of 935 articles,19 met the inclusion criteria.Ten articles focused on diagnostic EUS,while nine focused on EUSguided therapeutic interventions.EUS fine-needle aspiration demonstrated superior sensitivity[0.43-1.00;95%confidence interval(CI):0.24-1.00]compared to conventional techniques(0.36-0.96;95%CI:0.19-0.99)for diagnosing malignant biliary strictures.Both EUS-fine-needle aspiration and conventional methods exhibited high specificity,with most achieving 100%specificity.EUS-guided interventions showed significantly higher clinical success rates than control interventions(odds ratio=2.89;95%CI:1.22-6.84;P=0.02).No significant difference was observed in technical success rates(odds ratio=0.97;95%CI:0.30-3.16;P=0.96).CONCLUSION EUS is a promising tool for diagnosing and managing biliary strictures.Combining EUS-guided and conventional interventions improves diagnostic performance.Further research is needed to investigate the feasibility and use of EUS-guided interventions in this field.
文摘Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pathology.A positive histological diagnosis is always preferred prior to high risk hepatobiliary surgery,or to inform other types of therapy.Endoscopic retrograde cholangiopancreato-graphy with brushings has low sensitivity and despite significant improvements in instruments there is still an unacceptably high false negative rate.Other methods such as endoscopic ultrasound and cholangioscopy have improved diagnostic quality.In this review we explore the techniques available to aid accurate diagnosis of indeterminate biliary strictures and obtain accurate histology to facilitate clinical management.
文摘Biliary complications are still the main complications for liver transplantation recipients. Biliary strictures comprise the major part of all biliary complications after deceased-donor liver transplantation (LT). Biliary strictures following LT are divided into anastomotic strictures (AS) and non-anastomotic strictures (NAS). A Limitation of current published researches is that most studies aren’t based on clinical practice. The aim of this review is to summarize risk factors, clinical presentation, diagnosis and management in post-LT biliary strictures.
