BACKGROUND Crohn's disease(CD)frequently leads to intestinal strictures,which pose significant challenges due to their complexity and limited treatment options.While medications can address inflammatory strictures...BACKGROUND Crohn's disease(CD)frequently leads to intestinal strictures,which pose significant challenges due to their complexity and limited treatment options.While medications can address inflammatory strictures,they are largely ineffective for fibrotic and mixed strictures,often necessitating surgical intervention.However,surgery carries considerable risks,including bleeding,infection,anastomotic leaks,and postoperative restricture formation.Endoscopic treatment,particularly endoscopic stricturotomy,offers a minimally invasive alternative that bridges the gap between medication and surgery.AIM To investigate the safety and efficacy of stricturotomy under single-balloon enteroscopy in stricturing CD.METHODS Patients diagnosed with stricturing CD at The First People's Hospital of Changzhou from June 2020 to April 2024 were enrolled and underwent endoscopic stricturotomy(ES).Relevant clinical data of patients were collected retrospectively.Outcomes included success rate,remission time,complications,and follow-up interventions.This observational study was followed up postoperatively to observe patient remission and recurrence rates.RESULTS Seventeen endoscopic strictures were created in 11 patients,achieving a 100%immediate success rate without any serious complications.During the follow-up period,stricture recurrence was observed in two patients,resulting in an endoscopic reintervention rate of 18.2%.Additionally,two patients required subsequent surgical intervention,with a surgical treatment rate of 18.2%.One patient experienced bowel obstruction 18 months post-ES and was successfully managed with conservative treatment without surgical intervention.The remission duration after the initial ES treatment was 10.1±8.2 months,with a median remission time of 10 months.CONCLUSION ES is a safe and effective treatment for CD-related strictures and warrants further clinical promotion and application.展开更多
Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract.The incidence of pediatric CD is increasing and is currently 2.5-11.4 per 100000 world-wide.Notably,approximately 25%of children with CD dev...Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract.The incidence of pediatric CD is increasing and is currently 2.5-11.4 per 100000 world-wide.Notably,approximately 25%of children with CD develop stricturing CD(SCD)that requires intervention.Symptomatic stricturing diseases refractory to pharmacological management frequently require non-pharmacological interventions.Non-pharmacological therapeutic strategies include endoscopic balloon dilatation,stricturoplasty,and surgical resection of the strictured seg-ment.However,strictures tend to recur postoperatively regardless of treatment modality.The lifetime risk of surgery in patients with childhood SCD remains at 50%-90%.Thus,new and emerging strategies,advanced diagnostic tools,and minimally invasive approaches are under investigation to improve the outcomes and overall quality of life of pediatric patients with SCD.展开更多
Crohn's disease(CD) is a chronic remittent idiopathic disease. Although the early phase of the disease is commonly characterized by inflammation-driven symptoms, such as diarrhea, the frequency of fibrostenotic co...Crohn's disease(CD) is a chronic remittent idiopathic disease. Although the early phase of the disease is commonly characterized by inflammation-driven symptoms, such as diarrhea, the frequency of fibrostenotic complications in patients with CD increases over the long-term course of the disease. This review presents the current diagnostic options for assessing CD-associated strictures. In addition to the endoscopic evaluation of CD strictures, this review summarizes the currently available imaging modalities, including ultrasound and cross-sectional imaging techniques. In addition to stricture detection, differentiating between the primarily inflammatory strictures and the predominantly fibrotic ones is essential for selecting the appropriate treatment strategy(anti-inflammatory medical treatment vs endoscopical or surgical approaches). Therefore, recent imaging advances, such as contrast-enhanced ultrasound and ultrasound elastography, contribute to the development of noninvasive non-radiating imaging of CD-associated strictures. Finally, novel magnetic resonance imaging techniques, such as diffusion-weighted, motility and magnetization transfer imaging, as well as 18F-FDG PET/CT, molecular imaging approaches and biomarkers, are critically reviewed with regard to their potential role in assessing stricturing CD.展开更多
BACKGROUND Crohn’s disease(CD)has a multitude of complications including intestinal strictures from fibrostenotic disease.Fibrostenotic disease has been reported in 10%-17%of children at presentation and leads to sur...BACKGROUND Crohn’s disease(CD)has a multitude of complications including intestinal strictures from fibrostenotic disease.Fibrostenotic disease has been reported in 10%-17%of children at presentation and leads to surgery in 20%-50%of cases within ten years of diagnosis.When symptoms develop from these strictures,the treatment in children has primarily been surgical resection.Endoscopic balloon dilation(EBD)has been shown to be a safe and efficacious alternative to surgery in adults,but evidence is poor in the literature regarding its safety and efficacy in children.AIM To evaluate the outcomes of children with fibrostenosing CD who underwent EBD vs surgery as a treatment.METHODS In a single-center retrospective study,we looked at pediatric patients(ages 0-18)who carry the diagnosis of CD,who were diagnosed after opening a dedicated Inflammatory Bowel Disease clinic on July 1,2012 through May 1,2019.We used diagnostic codes through our electronic medical record to identify patients with CD with a stricturing phenotype.The type of intervention for patients’strictures was then identified through procedural and surgical billing codes.We evaluated their demographics,clinical variables,whether they underwent EBD vs surgery or both,and their clinical outcomes.RESULTS Of the 139 patients with CD,25(18%)developed strictures.The initial intervention for a stricture was surgical resection in 12 patients(48%)and EBD in 13 patients(52%).However,4(33%)patients whom initially had surgical resection required follow up EBD,and thus 17 total patients(68%)underwent EBD at some point in their treatment process.For those 8 patients who underwent successful surgical resection alone,4 of these patients(50%)had a fistula present near the stricture site and 4(50%)had strictures greater than 5 cm in length.All patients who underwent EBD had no procedural complications,such as a perforation.Twenty-two(88%)of the treated strictures were successfully managed by EBD and did not require any further surgical intervention during our follow up period.CONCLUSION EBD is safe and efficacious as an alternative to surgery for palliative management of strictures in selected pediatric patients with CD.展开更多
BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD....BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.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
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
The case report by Elsayed et al presented a multidisciplinary approach to treating recurrent biliary strictures following proximal bile duct injury.Bioresorbable biliary stents,an innovative option for managing bilia...The case report by Elsayed et al presented a multidisciplinary approach to treating recurrent biliary strictures following proximal bile duct injury.Bioresorbable biliary stents,an innovative option for managing biliary strictures in recent years,are a key part of this approach.Unlike traditional metal/plastic stents,bioresorbable stents made from materials like polylactic acid(PLA)or polycaprolactone gradually degrade in the body.This eliminates the need for endoscopic removal,reducing patient trauma and costs.Nondegradable stents often lead to complications such as restenosis,migration,or infection.In contrast,bioresorbable stents can have their degradation rate tailored to the bile duct healing process(e.g.,PLA stents remained unobstructed for 25.7 weeks in a porcine model),minimizing long-term complications.We analyzed the advantages and disadvantages of bioresorbable stents,outlined future research directions,and aimed to offer valuable insights for clinical practice.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
Introduction:Distal ureteral obstruction has classically been managed by ureteroneocystostomy(UNC).The feasibility and success of robotic primary ureteroureterostomy(UU)for benign obstruction appears promising with se...Introduction:Distal ureteral obstruction has classically been managed by ureteroneocystostomy(UNC).The feasibility and success of robotic primary ureteroureterostomy(UU)for benign obstruction appears promising with several benefits over UNC but is poorly studied.Robotic repair offers superior visualization and precision,allowing for minimal ureteral dissection.Here we report on our experience and short-term outcomes.Materials and Methods:We identified patients who underwent robotic distal ureteroureterostomy for benign distal ureteral obstruction at our institution from 2020–2024.Etiology,stricture length,and post-operative outcomes were recorded.All patients had renal ultrasound(US),diuretic renography,or cross-sectional imaging within 6 months of repair.Results:Seven patients underwent distal UU from 2020–2024,with one case of bilateral repair for a total of 8 anastomoses.Iatrogenic injury from hysterectomy represented 5/8 injuries.The mean time between injury and repair was 3.5 months.All defects were 1–1.5 cm in length.At follow-up imaging,there was no evidence of obstruction in any patient with a median follow-up of 10 months,including diuretic renography in 5 of 7 patients.One patient had mild hydronephrosis on their initial renal US but with normal drainage on subsequent diuretic renography.All patients reported no flank pain at follow-up.Conclusions:Robotic UU is feasible for short,benign distal ureteral obstruction in carefully selected patients.Advantages over traditional UNC include a significantly shorter catheter time,no risk of vesicoureteral reflux,no effect on bladder capacity or function,and the ability to retain the native ureteral orifice.Continued research will elucidate the long-term efficacy of this approach.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 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
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 Relative changes in the prevalence of gastrointestinal(GI)diseases have been reported worldwide over the past decades.However,data on changing trends of upper GI diseases remain scarce in sub-Saharan Africa...BACKGROUND Relative changes in the prevalence of gastrointestinal(GI)diseases have been reported worldwide over the past decades.However,data on changing trends of upper GI diseases remain scarce in sub-Saharan Africa.This study examines the shifting patterns of upper GI endoscopic findings over 35 years in Ethiopia.AIM To analyze trends in upper GI endoscopic findings over two distinct time periods,35 years apart,in Ethiopia.METHODS We extracted findings from 8412 upper GI endoscopies performed between 2016 and 2024 at a tertiary referral center in Addis Ababa,Ethiopia.Patient characteristics,indications,and endoscopic findings were analyzed using descriptive statistics and presented in tables,map and graphs.These findings were compared to 10000 procedures conducted between 1979 and 1994.Key endoscopic findings were identified,and percentage changes in disease prevalence were calculated.RESULTS Between the two study periods,the male-to-female ratio of patients undergoing upper GI endoscopy shifted from 2:1 to 1.4:1,while the median patient age increased from 36 to 40 years.The proportion of patients older than 50 years doubled(14.6%to 30.2%),and referrals from outside Addis Ababa increased from 33%to 57%.The prevalence of peptic ulcer disease and its complications decreased from 46.2%to 9.5%.Conversely,gastroesophageal varices increased from 9.5%to 21.8%,and upper GI malignancies rose from 3.6%to 18.8%.CONCLUSION This study sheds light on critical epidemiological shifts in upper GI diseases in Ethiopia,with a decline in peptic ulcer disease and a rise in portal hypertensive lesions and malignancies which have important public health implications.These findings underscore the need for increased awareness,improved clinical practices,enhanced resource allocation,and expanded access to early diagnosis and treatment of prevailing conditions.Preventive strategies targeting immunization and treatment of viral hepatitis,schistosomiasis,and Helicobacter pylori infection are urgently needed.展开更多
We recently read with interest the article by Chi et al published in the World Journal of Gastroenterology.In this article,the authors reported a novel technique for re-establishing luminal continuity in a completely ...We recently read with interest the article by Chi et al published in the World Journal of Gastroenterology.In this article,the authors reported a novel technique for re-establishing luminal continuity in a completely occluded colorectal anastomosis involving two endoscopes,one for radial electrical incision and the other serving as a guide light.However,this technique can be applied only in selected cases.Given the absence of a standardized guideline-based algorithm for the management of complete anastomotic obstruction,by reviewing the available literature,we provide a brief overview of relevant endoscopic techniques while underlining their importance in the management of this postoperative complication to provide clinicians with the necessary knowledge to improve their daily practice.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
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
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 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
Liver transplantation is the primary therapeutic choice for end-stage liver disease.Currently,biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipi...Liver transplantation is the primary therapeutic choice for end-stage liver disease.Currently,biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipients.Nevertheless,the clinical manifestations of biliary complications following liver transplantation are often non-specific,making early diagnosis and timely treatment crucial for improving patient outcomes.Ultrasound is the preferred imaging method following liver transplantation.Importantly,contrast-enhanced ultrasound,with the adminis-tration of contrast agents,can improve the resolution of biliary images and enable real-time,dynamic visualization of microcirculation perfusion in the biliary system and surrounding tissues.The present article describes the normal ultra-sonic features of the biliary system following liver transplantation and briefly reviews the progress in the ultrasonic diagnosis of common biliary complications,including anastomotic biliary strictures,non-anastomotic biliary strictures,biliary leakage,biloma,and bile sludge/bile stone.展开更多
文摘BACKGROUND Crohn's disease(CD)frequently leads to intestinal strictures,which pose significant challenges due to their complexity and limited treatment options.While medications can address inflammatory strictures,they are largely ineffective for fibrotic and mixed strictures,often necessitating surgical intervention.However,surgery carries considerable risks,including bleeding,infection,anastomotic leaks,and postoperative restricture formation.Endoscopic treatment,particularly endoscopic stricturotomy,offers a minimally invasive alternative that bridges the gap between medication and surgery.AIM To investigate the safety and efficacy of stricturotomy under single-balloon enteroscopy in stricturing CD.METHODS Patients diagnosed with stricturing CD at The First People's Hospital of Changzhou from June 2020 to April 2024 were enrolled and underwent endoscopic stricturotomy(ES).Relevant clinical data of patients were collected retrospectively.Outcomes included success rate,remission time,complications,and follow-up interventions.This observational study was followed up postoperatively to observe patient remission and recurrence rates.RESULTS Seventeen endoscopic strictures were created in 11 patients,achieving a 100%immediate success rate without any serious complications.During the follow-up period,stricture recurrence was observed in two patients,resulting in an endoscopic reintervention rate of 18.2%.Additionally,two patients required subsequent surgical intervention,with a surgical treatment rate of 18.2%.One patient experienced bowel obstruction 18 months post-ES and was successfully managed with conservative treatment without surgical intervention.The remission duration after the initial ES treatment was 10.1±8.2 months,with a median remission time of 10 months.CONCLUSION ES is a safe and effective treatment for CD-related strictures and warrants further clinical promotion and application.
文摘Crohn’s disease(CD)is a chronic inflammatory disease of the digestive tract.The incidence of pediatric CD is increasing and is currently 2.5-11.4 per 100000 world-wide.Notably,approximately 25%of children with CD develop stricturing CD(SCD)that requires intervention.Symptomatic stricturing diseases refractory to pharmacological management frequently require non-pharmacological interventions.Non-pharmacological therapeutic strategies include endoscopic balloon dilatation,stricturoplasty,and surgical resection of the strictured seg-ment.However,strictures tend to recur postoperatively regardless of treatment modality.The lifetime risk of surgery in patients with childhood SCD remains at 50%-90%.Thus,new and emerging strategies,advanced diagnostic tools,and minimally invasive approaches are under investigation to improve the outcomes and overall quality of life of pediatric patients with SCD.
文摘Crohn's disease(CD) is a chronic remittent idiopathic disease. Although the early phase of the disease is commonly characterized by inflammation-driven symptoms, such as diarrhea, the frequency of fibrostenotic complications in patients with CD increases over the long-term course of the disease. This review presents the current diagnostic options for assessing CD-associated strictures. In addition to the endoscopic evaluation of CD strictures, this review summarizes the currently available imaging modalities, including ultrasound and cross-sectional imaging techniques. In addition to stricture detection, differentiating between the primarily inflammatory strictures and the predominantly fibrotic ones is essential for selecting the appropriate treatment strategy(anti-inflammatory medical treatment vs endoscopical or surgical approaches). Therefore, recent imaging advances, such as contrast-enhanced ultrasound and ultrasound elastography, contribute to the development of noninvasive non-radiating imaging of CD-associated strictures. Finally, novel magnetic resonance imaging techniques, such as diffusion-weighted, motility and magnetization transfer imaging, as well as 18F-FDG PET/CT, molecular imaging approaches and biomarkers, are critically reviewed with regard to their potential role in assessing stricturing CD.
文摘BACKGROUND Crohn’s disease(CD)has a multitude of complications including intestinal strictures from fibrostenotic disease.Fibrostenotic disease has been reported in 10%-17%of children at presentation and leads to surgery in 20%-50%of cases within ten years of diagnosis.When symptoms develop from these strictures,the treatment in children has primarily been surgical resection.Endoscopic balloon dilation(EBD)has been shown to be a safe and efficacious alternative to surgery in adults,but evidence is poor in the literature regarding its safety and efficacy in children.AIM To evaluate the outcomes of children with fibrostenosing CD who underwent EBD vs surgery as a treatment.METHODS In a single-center retrospective study,we looked at pediatric patients(ages 0-18)who carry the diagnosis of CD,who were diagnosed after opening a dedicated Inflammatory Bowel Disease clinic on July 1,2012 through May 1,2019.We used diagnostic codes through our electronic medical record to identify patients with CD with a stricturing phenotype.The type of intervention for patients’strictures was then identified through procedural and surgical billing codes.We evaluated their demographics,clinical variables,whether they underwent EBD vs surgery or both,and their clinical outcomes.RESULTS Of the 139 patients with CD,25(18%)developed strictures.The initial intervention for a stricture was surgical resection in 12 patients(48%)and EBD in 13 patients(52%).However,4(33%)patients whom initially had surgical resection required follow up EBD,and thus 17 total patients(68%)underwent EBD at some point in their treatment process.For those 8 patients who underwent successful surgical resection alone,4 of these patients(50%)had a fistula present near the stricture site and 4(50%)had strictures greater than 5 cm in length.All patients who underwent EBD had no procedural complications,such as a perforation.Twenty-two(88%)of the treated strictures were successfully managed by EBD and did not require any further surgical intervention during our follow up period.CONCLUSION EBD is safe and efficacious as an alternative to surgery for palliative management of strictures in selected pediatric patients with CD.
基金Supported by Science and Technology Department of Sichuan Province,No.2020YFS0376National Natural Science Foundation of China,No.81900599Science and Technology Program of Hospital of TCM,Southwest Medical University,No.2022-CXTD-01.
文摘BACKGROUND Esophageal stricture ranks among the most significant complications following endoscopic submucosal dissection(ESD).Excessive fibrotic repair is a typical pathological feature leading to stenosis after ESD.AIM To examine the effectiveness and underlying mechanism of Kangfuxin solution(KFX)in mitigating excessive fibrotic repair of the esophagus post-ESD.METHODS Pigs received KFX at 0.74 mL/kg/d for 21 days after esophageal full circumferential ESD.Endoscopic examinations occurred on days 7 and 21 post-ESD.In vitro,recombinant transforming growth factor(TGF)-β1(5 ng/mL)induced a fibrotic microenvironment in primary esophageal fibroblasts(pEsF).After 24 hours of KFX treatment(at 1.5%,1%,and 0.5%),expression ofα-smooth muscle actin-2(ACTA2),fibronectin(FN),and type collagen I was assessed.Profibrotic signaling was analyzed,including TGF-β1,Smad2/3,and phosphor-smad2/3(p-Smad2/3).RESULTS Compared to the Control group,the groups treated with KFX and prednisolone exhibited reduced esophageal stenosis,lower weight loss rates,and improved food tolerance 21 d after ESD.After treatment,Masson staining revealed thinner and less dense collagen fibers in the submucosal layer.Additionally,the expression of fibrotic effector molecules was notably inhibited.Mechanistically,KFX downregulated the transduction levels of fibrotic functional molecules such as TGF-β1,Smad2/3,and p-Smad2/3.In vitro,pEsF exposed to TGF-β1-induced fibrotic microenvironment displayed increased fibrotic activity,which was reversed by KFX treatment,leading to reduced activation of ACTA2,FN,and collagen I.The 1.5%KFX treatment group showed decreased expression of p-Smad 2/3 in TGF-β1-activated pEsF.CONCLUSION KFX showed promise as a therapeutic option for post-full circumferential esophageal ESD strictures,potentially by suppressing fibroblast fibrotic activity through modulation of the TGF-β1/Smads signaling pathway.
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.
基金Supported by PhD Supervisor Training Program,No.22GSSYA-3Gansu Provincial Health Industry Research Project,No.GSWSKY2020-45Gansu Natural Science Foundation,No.20JR10RA378.
文摘The case report by Elsayed et al presented a multidisciplinary approach to treating recurrent biliary strictures following proximal bile duct injury.Bioresorbable biliary stents,an innovative option for managing biliary strictures in recent years,are a key part of this approach.Unlike traditional metal/plastic stents,bioresorbable stents made from materials like polylactic acid(PLA)or polycaprolactone gradually degrade in the body.This eliminates the need for endoscopic removal,reducing patient trauma and costs.Nondegradable stents often lead to complications such as restenosis,migration,or infection.In contrast,bioresorbable stents can have their degradation rate tailored to the bile duct healing process(e.g.,PLA stents remained unobstructed for 25.7 weeks in a porcine model),minimizing long-term complications.We analyzed the advantages and disadvantages of bioresorbable stents,outlined future research directions,and aimed to offer valuable insights for clinical practice.
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Introduction:Distal ureteral obstruction has classically been managed by ureteroneocystostomy(UNC).The feasibility and success of robotic primary ureteroureterostomy(UU)for benign obstruction appears promising with several benefits over UNC but is poorly studied.Robotic repair offers superior visualization and precision,allowing for minimal ureteral dissection.Here we report on our experience and short-term outcomes.Materials and Methods:We identified patients who underwent robotic distal ureteroureterostomy for benign distal ureteral obstruction at our institution from 2020–2024.Etiology,stricture length,and post-operative outcomes were recorded.All patients had renal ultrasound(US),diuretic renography,or cross-sectional imaging within 6 months of repair.Results:Seven patients underwent distal UU from 2020–2024,with one case of bilateral repair for a total of 8 anastomoses.Iatrogenic injury from hysterectomy represented 5/8 injuries.The mean time between injury and repair was 3.5 months.All defects were 1–1.5 cm in length.At follow-up imaging,there was no evidence of obstruction in any patient with a median follow-up of 10 months,including diuretic renography in 5 of 7 patients.One patient had mild hydronephrosis on their initial renal US but with normal drainage on subsequent diuretic renography.All patients reported no flank pain at follow-up.Conclusions:Robotic UU is feasible for short,benign distal ureteral obstruction in carefully selected patients.Advantages over traditional UNC include a significantly shorter catheter time,no risk of vesicoureteral reflux,no effect on bladder capacity or function,and the ability to retain the native ureteral orifice.Continued research will elucidate the long-term efficacy of this approach.
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.
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.
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.
文摘BACKGROUND Relative changes in the prevalence of gastrointestinal(GI)diseases have been reported worldwide over the past decades.However,data on changing trends of upper GI diseases remain scarce in sub-Saharan Africa.This study examines the shifting patterns of upper GI endoscopic findings over 35 years in Ethiopia.AIM To analyze trends in upper GI endoscopic findings over two distinct time periods,35 years apart,in Ethiopia.METHODS We extracted findings from 8412 upper GI endoscopies performed between 2016 and 2024 at a tertiary referral center in Addis Ababa,Ethiopia.Patient characteristics,indications,and endoscopic findings were analyzed using descriptive statistics and presented in tables,map and graphs.These findings were compared to 10000 procedures conducted between 1979 and 1994.Key endoscopic findings were identified,and percentage changes in disease prevalence were calculated.RESULTS Between the two study periods,the male-to-female ratio of patients undergoing upper GI endoscopy shifted from 2:1 to 1.4:1,while the median patient age increased from 36 to 40 years.The proportion of patients older than 50 years doubled(14.6%to 30.2%),and referrals from outside Addis Ababa increased from 33%to 57%.The prevalence of peptic ulcer disease and its complications decreased from 46.2%to 9.5%.Conversely,gastroesophageal varices increased from 9.5%to 21.8%,and upper GI malignancies rose from 3.6%to 18.8%.CONCLUSION This study sheds light on critical epidemiological shifts in upper GI diseases in Ethiopia,with a decline in peptic ulcer disease and a rise in portal hypertensive lesions and malignancies which have important public health implications.These findings underscore the need for increased awareness,improved clinical practices,enhanced resource allocation,and expanded access to early diagnosis and treatment of prevailing conditions.Preventive strategies targeting immunization and treatment of viral hepatitis,schistosomiasis,and Helicobacter pylori infection are urgently needed.
文摘We recently read with interest the article by Chi et al published in the World Journal of Gastroenterology.In this article,the authors reported a novel technique for re-establishing luminal continuity in a completely occluded colorectal anastomosis involving two endoscopes,one for radial electrical incision and the other serving as a guide light.However,this technique can be applied only in selected cases.Given the absence of a standardized guideline-based algorithm for the management of complete anastomotic obstruction,by reviewing the available literature,we provide a brief overview of relevant endoscopic techniques while underlining their importance in the management of this postoperative complication to provide clinicians with the necessary knowledge to improve their daily practice.
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.
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.
基金Supported by the Shenzhen Third People’s Hospital Research Fund,No.25270G1043The Basic and Applied Basic Research Foundation of Guangdong Province,No.2025A1515011934.
文摘Liver transplantation is the primary therapeutic choice for end-stage liver disease.Currently,biliary complications are among the main factors affecting the survival rate and quality of life of liver transplant recipients.Nevertheless,the clinical manifestations of biliary complications following liver transplantation are often non-specific,making early diagnosis and timely treatment crucial for improving patient outcomes.Ultrasound is the preferred imaging method following liver transplantation.Importantly,contrast-enhanced ultrasound,with the adminis-tration of contrast agents,can improve the resolution of biliary images and enable real-time,dynamic visualization of microcirculation perfusion in the biliary system and surrounding tissues.The present article describes the normal ultra-sonic features of the biliary system following liver transplantation and briefly reviews the progress in the ultrasonic diagnosis of common biliary complications,including anastomotic biliary strictures,non-anastomotic biliary strictures,biliary leakage,biloma,and bile sludge/bile stone.
