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Journals Best Practice & Research. Clin...

Best Practice & Research. Clinical Gastroenterology

https://read.qxmd.com/read/36577530/endoscopic-ultrasound-guided-biliary-interventions
#61
REVIEW
Giuseppe Dell'Anna, Takeshi Ogura, Giuseppe Vanella, Hiroki Nishikawa, Sundeep Lakhtakia, Paolo Giorgio Arcidiacono
Endoscopic Retrograde Cholangiopancreatography (ERCP), even in expert hands, may fail in 5-10% of cases, especially in cases of papillary infiltration, malignant gastric outlet obstruction, or surgically altered anatomy. Percutaneous transhepatic biliary drainage (PTBD) has represented the traditional rescue therapy, despite associated with high rate of adverse events, need for re-interventions and an inferior quality of life. The evolution of Endoscopic Ultrasound (EUS) from a diagnostic to a therapeutic tool offers an effective and safe alternative for internal biliary drainage (BD) into the stomach or the duodenum...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/36577529/endoscopic-ultrasonography-enhancing-diagnostic-accuracy
#62
REVIEW
Julio Iglesias-Garcia, Jose Lariño-Noia, Daniel de la Iglesia-García, J Enrique Dominguez-Muñoz
Endoscopic ultrasound (EUS) is an essential technique for the management of several diseases. Over the years, new technologies have been developed because to improve and overcome certain limitations related to EUS guided tissue acquisition. Among these new methods, EUS guided elastography and contrast enhanced EUS has arisen as the most widely recognized and available. We will review in this manuscript the different techniques of elastography and contrast enhancement. Nowadays, there are well establish indications for advance imaging, mainly for supporting the management of pancreatic diseases (diagnosis of chronic pancreatitis and differential diagnosis of solid and cystic pancreatic tumors) and characterization of lymph nodes...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/36577528/the-use-of-endoscopic-ultrasound-in-the-management-of-post-surgical-and-pancreatic-fluid-collections
#63
REVIEW
Judy A Trieu, Todd H Baron
Fluid collections after abdominal surgeries, particularly pancreatic surgeries, are associated with high morbidity and mortality. Up until recently, percutaneous drainage was the first line therapy, but not without disadvantages, including high maintenance, risk of infection and chronic fistulas, electrolyte losses, and impact on quality of life. Endoscopic ultrasound (EUS)-guided drainage of post-surgical fluid collections (PSFCs) is safe and effective, carrying similar success, adverse event (AE), and recurrence rates as percutaneous drainage...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/36577527/endoscopic-ultrasound-in-the-management-of-acute-cholecystitis
#64
REVIEW
J L Teh, Mihai Rimbas, Alberto Larghi, Anthony Yuen Bun Teoh
Endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is increasingly utilised for patients with acute cholecystitis who are high-risk candidates for surgery. The technique to perform EUS-GBD has evolved and matured over the last two decades since EUS-GBD was first described in 2007 using a nasobiliary catheter. Compared to percutaneous gallbladder drainage (PT-GBD), EUS-GBD offers benefits of shorter hospitalisation stay and lesser procedural pain and need for reintervention. The purpose of this review is to provide an updated review of the equipment and techniques available for EUS-GBD, outcomes of the procedure and how it compares against endoscopic transpapillary drainage (ET-GBD), PT-GBD and laparoscopic cholecystectomy...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35988968/juvenile-polyposis-focus-on-less-described-manifestations
#65
REVIEW
Jean-Christophe Saurin, Laura Calavas, Claire Caillot
Juvenile polyposis represents an heterogeneous disease as different genetic dominant backgrounds have been evidenced leading to different clinical presentations. It is associated in some patients with a different syndrome, Hereditary Hemorragic Telangiectasia, justifying a complementary and different management. Recent international recommendations help in managing this very rare disease, and this management should probably be restricted to expert centers able to take care of the multiple manifestations and risks of these patients and families...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35988967/familial-colorectal-cancer
#66
REVIEW
Carolina Mangas-Sanjuan, Rodrigo Jover
The introduction of average-risk colorectal cancer (CRC) screening programs means that many subjects with family history of CRC and without well-described inherited syndromes can benefit from these public health policies. Therefore, the definition of which individuals should be named under the umbrella of the term "familial CRC" should be reconsidered to include only those who are outside of the protection of population-based screening and need to be moved towards a more intensive surveillance strategy. Two subgroups have been reported as having a high enough CRC risk to be included within the term "familial risk of CRC": individuals who have ≥1 first degree relative (FDR) with CRC diagnosed at age <50 years, and those who have ≥2 FDRs with CRC...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35988966/management-of-familial-adenomatous-polyposis-and-mutyh-associated-polyposis-new-insights
#67
REVIEW
Arthur S Aelvoet, Francesco Buttitta, Luigi Ricciardiello, Evelien Dekker
Familial adenomatous polyposis (FAP) and MUTYH-associated polyposis (MAP) are rare inherited polyposis syndromes with a high colorectal cancer (CRC) risk. Therefore, frequent endoscopic surveillance including polypectomy of relevant premalignant lesions from a young age is warranted in patients. In FAP and less often in MAP, prophylactic colectomy is indicated followed by lifelong endoscopic surveillance of the retained rectum after (sub)total colectomy and ileal pouch after proctocolectomy to prevent CRC. No consensus is reached on the right type and timing of colectomy...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35988965/gastrointestinal-manifestations-in-pten-hamartoma-tumor-syndrome
#68
REVIEW
Giuseppe D'Ermo, Maurizio Genuardi
The PTEN hamartoma tumor syndrome (PHTS) is a heterogeneous set of multisystem disorders caused by germline pathogenic variants in the PTEN tumor suppressor gene. Manifestations include developmental anomalies and proliferative lesions. Evidence of involvement of the GI tract has accrued over time, leading to the incorporation of GI manifestations (multiple hamartomas, glycogenic acanthosis and colorectal cancer) into the diagnostic criteria. Polyps of the upper and lower GI tract are found in most adult patients and in a significant fraction of children...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35988964/lynch-syndrome-towards-more-personalized-management
#69
REVIEW
Joan Llach, Maria Pellisé, Kevin Monahan
Lynch syndrome is the most common inherited cause of colorectal (lifetime risk up to 70%) and endometrial cancer. The diagnosis of Lynch syndrome facilitates preventive measures aimed at reducing the incidence and mortality of cancer. Colonoscopic surveillance for colorectal cancer, aspirin, and prophylactic hysterectomy and bilateral salpo-oopherectomy for endometrial and/or ovarian cancer have demonstrated to effectively reduce cancer mortality in this population. However, the lifetime risk of each cancer in people with Lynch syndrome is gene-specific and may be modified by environmental factors...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35988962/juvenile-polyposis-syndrome-an-overview
#70
REVIEW
Arianna Dal Buono, Federica Gaiani, Laura Poliani, Luigi Laghi
Juvenile polyposis syndrome (JPS) is a rare precancerous condition that confers an increased risk of developing gastrointestinal cancers. The inheritance pattern is autosomal dominant. JPS should be clinically suspected when the other hamartomatous polyposis syndromes are excluded (i.e., Peutz- Jeghers and Cowden), in presence of numerous juvenile polyps in the colorectum or in other GI locations. Among the syndromic features, JPS can present with concomitant extra-intestinal manifestations, above all cutaneous manifestations such as telangiectasia, pigmented nevi, and skeletal stigmata...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35988960/serrated-polyposis-syndrome-epidemiology-and-management
#71
REVIEW
S Carballal, F Balaguer, J E G IJspeert
Serrated colorectal polyps, long considered innocent, are currently recognized as the precursors to one-third of all colorectal cancers (CRC). Serrated polyposis syndrome (SPS), characterized by accumulation of multiple and/or large serrated polyps, symbolizes the highest expression of serrated pathway of carcinogenesis, leading to a high risk of CRC when it is not detected or treated on time. Although previously considered uncommon, SPS is now acknowledged as the most prevalent colorectal polyposis. This syndrome has attracted increasing interest over the past decade and has become a hot topic in the field of gastrointestinal oncology...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35988957/hereditary-pancreatic-cancer
#72
REVIEW
Derk C F Klatte, Michael B Wallace, Matthias Löhr, Marco J Bruno, Monique E van Leerdam
Pancreatic cancer is one of the deadliest malignancies. Therefore, there is an urgent need to detect pancreatic cancer in an earlier stage to improve outcomes. A variety of hereditary cancer syndromes have been associated with an increased risk of developing pancreatic cancer, and these individuals may benefit from surveillance programs. Surveillance programs have shown potential to improve outcomes, but have important risks such as overtreatment. In this review we will discuss the definitions and epidemiology of hereditary pancreatic cancer, recommendations for genetic testing and participation in surveillance...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35331405/wilson-s-disease-management-and-long-term-outcomes
#73
REVIEW
Piotr Socha, Anna Czlonkowska, Wojciech Janczyk, Tomasz Litwin
Wilson's disease (WD) is an autosomal recessive genetic disorder of copper metabolism leading to liver or brain injury due to accumulation of copper. Diagnosis is based on: clinical features, biochemical tests including plasma ceruloplasmin concentration, 24h urinary copper excretion, copper content in the liver, and molecular analysis. Pharmacological therapy comprises chelating agents (penicillamine, trientine) and zinc salts which seem to be very effective. Still, poor compliance is a major problem. Adolescents and patients with psychiatric disorders usually have problems with adherence to treatment...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35331404/long-term-outcomes-of-biliary-atresia-patients-surviving-with-their-native-livers
#74
REVIEW
Maria Hukkinen, Satu Ruuska, Marjut Pihlajoki, Antti Kyrönlahti, Mikko P Pakarinen
Portoenterostomy (PE) has remained as the generally accepted first line surgical treatment for biliary atresia (BA) for over 50 years. Currently, close to half of BA patients survive beyond 10 years with their native livers, and most of them reach adulthood without liver transplantation (LT). Despite normalization of serum bilirubin by PE, ductular reaction and portal fibrosis persist in the native liver. The chronic cholangiopathy progresses to cirrhosis, complications of portal hypertension, recurrent cholangitis or hepatobiliary tumors necessitating LT later in life...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35331400/digestive-outcomes-in-cystic-fibrosis
#75
REVIEW
Delphine Ley, Dominique Turck
Cystic fibrosis (CF) is the most frequent life-limiting autosomal recessive disease in Caucasians, affecting the respiratory tract, but also the pancreas, gut, and hepatobiliary tract. CF is caused by variants in the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) gene. Prognosis of CF has markedly improved over the last 20 years because of the management in CF centers and recent introduction of CFTR modulators, aimed at correcting the defective CFTR protein. There are nowadays more CF adults than children, with a predicted median survival age of around 50 years in high-income countries...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35331397/congenital-disorders-of-intestinal-digestion-and-absorption-sugars-proteins-lipids-ions
#76
REVIEW
Noel Peretti, Emmanuel Mas
Congenital diarrhea may result from 2 main different mechanisms: 1) osmotic diarrhea is caused by the non-digestion-absorption of nutrients leading to the non-absorbed nutrients going into the lumen, increasing the osmotic force and driving fluids; 2) secretory diarrhea induced by the inhibition of intestinal absorption of electrolytes, increasing electrolyte and water flux towards the intestinal lumen. The malabsorption of macronutrients (carbohydrates, proteins and lipids) induces energy deficiency with symptoms depending on the macronutrient: carbohydrates with watery acidic diarrhea; protein with rapid malnutrition, edema, and hypoalbuminemia; and lipids with malnutrition, steatorrhea and hypocholesterolemia...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/35331396/congenital-enteropathies-involving-defects-in-enterocyte-structure-or-differentiation
#77
REVIEW
Olivier Goulet, Bénédicte Pigneur, Fabienne Charbit-Henrion
Congenital enteropathies (CE) are a group of rare inherited diseases with a typical onset early in life. They involve defects in enterocyte structure or differentiation. They can cause a severe condition of intestinal failure (IF). The diagnostic approach is based first on clinical presentation (consanguinity, prenatal expression, polyhydramnios, early neonatal onset, aspect of stools, persistence at bowel rest, associated extra-digestive manifestations….) and histo-pathological analyses. These rare intestinal diseases cause protracted diarrhea that might resolve, for a few, with a dietetic approach...
2022: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/34874848/immunosuppression-in-liver-and-intestinal-transplantation
#78
REVIEW
Jan P Lerut, Gabriel E Gondolesi
Immunosuppression handling plays a key role in the early and long-term results of transplantation. The development of multiple immunosuppressive drugs led to numerous clincial trials searching to reach the ideal regimen. Due to heterogeneity of the studied patient cohorts and flaws in many, even randomized controlled, study designs, the answer still stands out. Nowadays triple-drug immunosuppression containing a calcineurin inhibitor (preferentially tacrolimus), an antimetabolite (using mycophenolate moffettil or Azathioprine) and short-term steroids with or without induction therapy (using anti-IL2 receptor blocker or anti-lymphocytic serum) is the preferred option in both liver and intestinal transplantation...
October 2021: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/34874847/preface-immunosuppression-in-gastroenterology-and-hepatology
#79
EDITORIAL
James Neuberger
No abstract text is available yet for this article.
October 2021: Best Practice & Research. Clinical Gastroenterology
https://read.qxmd.com/read/34874846/new-agents-for-immunosuppression
#80
REVIEW
André Jefremow, Markus F Neurath
The human abdomen harbors organs that the host's immune system can attack easily. This immunological storm front leads to diseases like Crohn's Disease, Ulcerative Colitis or Autoimmune Hepatitis. Serious symptoms like pain, diarrhea, fatigue, or malnutrition accompany these diseases. Moreover, many patients have an increased risk for developing special kind of malignancies and some autoimmune disease can show a high mortality. The key to treat them consists of a deep understanding of their pathophysiology...
October 2021: Best Practice & Research. Clinical Gastroenterology
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