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Holubar SD, Nachand D, Lavryk O, Belkovsky M, Brienza R, Mohammed N, Ream J, Hull T, Steele SR, Regueiro M, Cohen BL, Qazi T, Rieder F. 3-Dimensional Pouchography: A Proof-of-Concept Study of a Novel Technique for Visualizing Ileoanal Pouch Anatomy & Morphology in Normal and Mechanical Pouch Complication Patients. J Crohns Colitis 2024:jjae058. [PMID: 38647203 DOI: 10.1093/ecco-jcc/jjae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Herein, we present a proof-of-concept study of 3-dimensional (3D) pouchography using virtual and printed 3D models of ileal pouch-anal anastomosis (IPAA) in patients with normal pouches and in cases of mechanical pouch complications. MATERIALS & METHODS We performed a retrospective, descriptive case series of a convenience sample of 10 pouch patients with or without pouch dysfunction who had CT scans appropriate for segmentation were identified from our pouch registry. The steps involved in clinician-driven automated 3D reconstruction are presented. RESULTS Three patients who underwent CT imaging and were found to have no primary pouch pathology, and seven patients with known pouch pathology identifiable with 3D reconstruction including pouch strictures, megapouch, pouch volvulus, and twisted pouches underwent 3D virtual modeling; one normal and one twisted pouch were 3D printed. We discovered that 3D pouchography reliably identified staple lines (pouch body, anorectal circular and transverse, and tip of J), the relationship between staple lines, and variations in pouch morphology, and pouch pathology. CONCLUSIONS Three-dimensional reconstruction of IPAA morphology is highly feasible using readily available technology. In our practice, we have found 3D pouchography to be an extremely useful adjunct to diagnose various mechanical pouch complications and improve planning for pouch salvage strategies. Given its ease of use and helpfulness in understanding the pouch structure and function, we have started to routinely integrate 3D pouchography into our clinical pouch referral practice. Further study is needed to formally assess to value of this technique to aid in the diagnosis of pouch pathology.
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Affiliation(s)
- Stefan D Holubar
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Douglas Nachand
- Department of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Olga Lavryk
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Mikhael Belkovsky
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Rita Brienza
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Nour Mohammed
- Department of Biomedical Engineering, Learner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Justin Ream
- Department of Abdominal Imaging, Imaging Institute, Cleveland Clinic, Cleveland, OH
| | - Tracy Hull
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Scott R Steele
- Department of Colon & Rectal Surgery, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Miguel Regueiro
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Benjamin L Cohen
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Taha Qazi
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases Institute, Cleveland Clinic, Cleveland, OH
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Zeng W, Chen Y, Yin B, Wen X, Xiao J, Luo L, Tang H, Zheng H. Analysis of the risk of future gastrointestinal surgery in Crohn's disease with stricture. Saudi J Gastroenterol 2024; 30:108-113. [PMID: 38011407 PMCID: PMC10980300 DOI: 10.4103/sjg.sjg_256_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/15/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Stricture in patients with Crohn's disease (CD) carries a high risk of CD-related surgery in the course of the disease. The aim of this study was to assess the rate of occurrence of CD-related surgery and to determine baseline risk factors predicting subsequent surgery in this patient group. METHODS Patients registered with stricturing CD were included. All baseline and follow-up data were collected retrospectively. Patients attended the clinic for follow-up at week 14 to assess their response to infliximab (IFX). CD-related surgery was the observational endpoint. Univariate and multivariate Cox regression analyses were used. RESULTS A total of 123 patients with stricturing CD were included in this study. The cumulative risk of CD-related surgery for years 1-5 after diagnosis was 18.0%, 26.7%, 32.6%, 40.7%, and 46.4%, respectively. Prior gastrointestinal (GI) surgery, low body mass index (BMI), and high platelet count might be risk factors for future CD-related surgery. With 97 participants treated by IFX, prior GI surgery and primary non-response (PNR) to IFX correlated with future CD-related surgery. CONCLUSION Prior GI surgery, BMI, and platelet counts were related to future CD-related surgery. Patients who were PNR to IFX had a higher risk of CD-related surgery in the future.
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Affiliation(s)
- Wen Zeng
- Department of Scientific Research and Teaching, Central Hospital of Shaoyang, Shaoyan, China
| | - Yong Chen
- Department of Oncology, Central Hospital of Shaoyang, Shaoyan, China
| | - Bolong Yin
- Department of Scientific Research and Teaching, Central Hospital of Shaoyang, Shaoyan, China
| | - Xue Wen
- Department of Scientific Research and Teaching, Central Hospital of Shaoyang, Shaoyan, China
- Graduate School, University of South China, China
| | - Jian Xiao
- Graduate School, University of South China, China
- Department of Hepatobiliary Surgery, Central Hospital of Shaoyang, Shaoyan, China
| | - Lian Luo
- Department of Oncology, Central Hospital of Shaoyang, Shaoyan, China
- Graduate School, University of South China, China
| | - Haiyuan Tang
- Department of Neurology and Stroke Center, Central Hospital of Shaoyang, Shaoyan, China
| | - He Zheng
- Department of Hepatobiliary Surgery, Central Hospital of Shaoyang, Shaoyan, China
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Pruijt MJ, de Voogd FAE, Montazeri NSM, van Etten-Jamaludin FS, D'Haens GR, Gecse KB. DIAGNOSTIC ACCURACY OF INTESTINAL ULTRASOUND IN THE DETECTION OF INTRA-ABDOMINAL COMPLICATIONS IN CROHN'S DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Crohns Colitis 2024:jjad215. [PMID: 38173288 DOI: 10.1093/ecco-jcc/jjad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Crohn's disease (CD) is frequently associated with the development of strictures and penetrating complications. Intestinal ultrasound (IUS) is a non-invasive imaging modality ideal for point-of-care assessment. In this systematic review and meta-analysis we provide a current overview on the diagnostic accuracy of IUS and its advanced modalities in the detection of intra-abdominal complications in CD compared to endoscopy, cross-sectional imaging, surgery and pathology. METHOD We conducted a literature search for studies describing diagnostic accuracy of IUS in adult patients with CD related intra-abdominal complications. Quality of the included studies was assessed with the QUADAS-2 tool. Meta-analysis was performed for both conventional IUS (B-mode) and oral contrast IUS (SICUS). RESULTS Of the 1498 studies we identified, 68 were included in this review and 23 studies (3863 patients) were used for the meta-analysis. Pooled sensitivities and specificities for strictures, inflammatory masses and fistulas by B-mode IUS were 0.81 and 0.90, 0.87 (sensitivities) and 0.95, and 0.67 and 0.97 (specificities), respectively. Pooled overall log diagnostic odds ratios were 3.56, 3.97 and 3.84 respectively. Pooled sensitivity and specificity of SICUS were 0.94 and 0.95, 0.91 and 0.97 (sensitivities), and 0.90 and 0.94 (specificities), respectively. Pooled overall log diagnostic odds ratio of SICUS were 4.51, 5.46 and 4.80, respectively. CONCLUSION IUS is accurate for the diagnosis of intra-abdominal complications in CD. As a non-invasive, point-of-care modality, IUS is recommended as the first-line imaging tool if there is a suspicion of CD-related intra-abdominal complications.
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Affiliation(s)
- Maarten J Pruijt
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Floris A E de Voogd
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Nahid S M Montazeri
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | | | - Geert R D'Haens
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
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Johnson N, Solkar M, Sehgal R, Riyad K. Non-steroidal anti-inflammatory drug induced intestinal stricturing: diaphragm disease. J Surg Case Rep 2024; 2024:rjad489. [PMID: 38250134 PMCID: PMC10799247 DOI: 10.1093/jscr/rjad489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/13/2023] [Indexed: 01/23/2024] Open
Abstract
Diaphragm disease (DD) is a rare small bowel enteropathy associated with non-steroidal anti-inflammatory drug use. Since the first description there have only been approximately 100 cases of DD reported in the literature. Stricturing webs or 'diaphragms' form in the bowel, causing non-specific abdominal symptoms that can ultimately lead to bleeding and obstruction. Diagnosis is notoriously challenging as there is no single gold standard investigation. We present two cases of DD both of which were ultimately diagnosed by surgical resection. We also propose a novel flow algorithm that can be utilized for working up patients with suspected DD.
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Affiliation(s)
- Nathan Johnson
- John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Maseera Solkar
- John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Rishabh Sehgal
- John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds LS9 7TF, United Kingdom
| | - Kallingal Riyad
- John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds LS9 7TF, United Kingdom
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Cortina LE, Wu MP, Meyer CD, Feng AL, Varvares MA, Richmon JD, Deschler DG, Lin DT. Predictors of multiple dilations and functional outcomes after total laryngectomy and laryngopharyngectomy. Head Neck 2024; 46:138-144. [PMID: 37908173 DOI: 10.1002/hed.27545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Following total laryngectomy (TL) or laryngopharyngectomy (TLP), patients may develop strictures that require multiple dilations to treat. However, the risk factors associated with dysphagia refractory to a single dilation are unknown. METHODS Single-institution retrospective review of patients who underwent at least one stricture dilation after TL/TLP between March 2013 and March 2022. RESULTS A total of 49 patients underwent stricture dilation after TL/TLP. Thirty-five (71%) underwent multiple dilations. Pharyngocutaneous fistula, primary chemoradiation therapy, and a shorter time interval from TL/TLP to first dilation were independently associated with dysphagia requiring multiple dilations. Patients in the multiple dilations group had a higher rate of limited diet and G-tube dependence compared to patients in the single dilation group. CONCLUSIONS Shorter time interval to stricture formation is a prognostic indicator of the need for multiple dilations following TL/TLP. Patients requiring multiple dilations are at increased risk of persistent dysphagia long-term.
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Affiliation(s)
- Luis E Cortina
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael P Wu
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Charles D Meyer
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Allen L Feng
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Mark A Varvares
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jeremy D Richmon
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Daniel G Deschler
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Derrick T Lin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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Saeedi A, Strum DP, Mir G, Chow MS, Bhatt N, Jacobson AS. Management of Enlarging Tracheoesophageal Fistula with Voice Prosthesis in Laryngectomized Patients. Laryngoscope 2024; 134:198-206. [PMID: 37366287 DOI: 10.1002/lary.30857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023]
Abstract
Management of Enlarging tracheoesophageal fistula (TEF) with Voice Prosthesis in Laryngectomized Head and Neck Cancer Patients. OBJECTIVES An enlarging TEF following voice prosthesis placement impacts patient quality of life, risks airway compromise, and can lead to aspiration pneumonia. Pharyngoesophageal strictures have previously been reported to be associated with TEF enlargement and leakage. We describe a series of patients with enlarging TEFs after Tracheoesophageal puncture (TEP) for voice prosthesis who required pharyngoesophageal reconstruction. METHODS Retrospective case series of laryngectomized H&N cancer patients with primary or secondary TEP who underwent surgical management for enlarging TEF site between 6/2016-11/2022. RESULTS Eight patients were included. The mean age was 62.8 years old. Seven patients had a history of hypothyroidism. Of seven with prior H&N radiation history, two had both historical and adjuvant radiation. Two of the eight TEPs were placed secondarily. Mean time from TEP to enlarging TEF diagnosis was 891.3 days. Radial forearm-free flaps were used in five patients. Six had stenosis proximal to the TEF whereas one had distal stenosis and one had no evidence of stenosis. Mean length of stay was 12.3 days. Mean follow-up was 400.4 days. Two required a second free flap for persistent fistula. CONCLUSION Surgical reconstruction of enlarging TEFs due to TEP/VP placement is effective in combination with addressing underlying pharyngeal/esophageal stenosis contributing to TEF enlargement and leakage. Radial forearm-free flaps have the additional benefit of a long vascular pedicle to access more distant and less-irradiated recipient vessels. Many fistulae are resolved after the first flap reconstruction, but some may require subsequent reconstruction in case of failure. LEVEL OF EVIDENCE 4 Laryngoscope, 134:198-206, 2024.
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Affiliation(s)
- Arman Saeedi
- Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, New York, U.S.A
| | - David P Strum
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Ghayoour Mir
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Michael S Chow
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Nupur Bhatt
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Adam S Jacobson
- Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
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Fansiwala K, Shah ND, McNulty KA, Kwaan MR, Limketkai BN. Use of oral diet and nutrition support in management of stricturing and fistulizing Crohn's disease. Nutr Clin Pract 2023; 38:1282-1295. [PMID: 37667524 DOI: 10.1002/ncp.11068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/25/2023] [Accepted: 08/06/2023] [Indexed: 09/06/2023] Open
Abstract
Crohn's disease (CD), a form of inflammatory bowel disease, involves chronic inflammation within the gastrointestinal tract. Intestinal strictures and fistulas are common complications of CD with varying severity in their presentations. Modifications in oral diet or use of exclusive enteral nutrition (EEN) are common approaches to manage both stricturing and fistulizing disease, although supporting research evidence is generally limited. In the preoperative period, there is strong evidence that EEN can reduce surgical complications. Parenteral nutrition (PN) is often utilized in the management of enterocutaneous fistulas, given that oral diet and EEN may potentially increase output in proximal fistulas. This narrative review highlights the current practices and evidence for the roles of oral diet, EEN, and PN in treatment and management of stricturing and fistulizing CD.
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Affiliation(s)
- Kush Fansiwala
- Vatche & Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Neha D Shah
- Colitis and Crohn's Disease Center, University of California, San Francisco, San Francisco, California, USA
| | - Kelly A McNulty
- Vatche & Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Mary R Kwaan
- Division of Colon and Rectal Surgery, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Berkeley N Limketkai
- Vatche & Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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Machida A, Abe M, Ishii S, Sekiguchi K, Takahashi K, Shiomi E, Maekawa S, Kato Y, Uesugi N, Obara W. A case of mid-ureteral stricture with ipsilateral atrophic kidney in a young adult. IJU Case Rep 2023; 6:349-352. [PMID: 37928301 PMCID: PMC10622214 DOI: 10.1002/iju5.12620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/21/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Most congenital ureteral strictures occur at the ureteropelvic or ureterovesical junction in children. Mid-ureteral stricture is very rare and can cause congenital hydronephrosis. Only a few studies have reported on coexisting mid-ureteral stricture with ipsilateral atrophic kidney in young adults. Case presentation A 16-year-old girl presented with repeated urinary tract infection. Computed tomography revealed a right atrophic kidney and hydroureter. Retrograde pyelography showed a mid-ureteral stricture. Laparoscopic nephroureterectomy was performed, and histological examination revealed mid-ureteral stricture with hyperplasia of the fibrous connective tissue and an atrophic kidney. Conclusion Mid-ureteral stricture in a young adult is extremely rare. Appropriate imaging studies including retrograde pyelography are necessary for accurate diagnosis of mid-ureteral stricture.
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Affiliation(s)
- Arisa Machida
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Masakazu Abe
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Shuhei Ishii
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Kie Sekiguchi
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Kenta Takahashi
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Ei Shiomi
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Shigekatsu Maekawa
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Yoichiro Kato
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
| | - Noriyuki Uesugi
- Department of PathologyIwate Medical University School of MedicineYahabaJapan
| | - Wataru Obara
- Department of UrologyIwate Medical University School of MedicineYahabaJapan
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Rossanese M, Giannarini G, Scalia R, Macchione L, Crestani A, Simonato A, Ficarra V. Outcomes and treatment failure after open or robotic ureteral reconstruction for iatrogenic injuries. BJUI Compass 2023; 4:673-679. [PMID: 37818024 PMCID: PMC10560615 DOI: 10.1002/bco2.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/28/2023] [Accepted: 06/04/2023] [Indexed: 10/12/2023] Open
Abstract
Objectives The aim of this study is to assess the aetiology, perioperative outcomes and treatment failure of contemporary patients undergoing open or robot-assisted ureteral reconstruction for iatrogenic injuries. Patients and methods We retrospectively analysed consecutive patients who underwent ureteral reconstruction for iatrogenic injuries at two academic centres 07/2013 and 06/2022. A variety of open or robot-assisted procedures were performed, including uretero-cystoneostomy, Boari bladder flap, uretero-ureterostomy, ileal replacement and pyelo-ureteroplasty. All procedures were performed by a single surgeon with extensive experience in open and robot-assisted surgery and preference-based management. Outcome measures were aetiology, estimated blood loss, length of stay, postoperative complications and treatment failure, defined as upper tract obstruction requiring permanent urinary drainage. We also planned a subgroup analysis comparing the outcomes between open and robot-assisted procedures. Results Fifty-nine patients were included. Most injuries were consequent to endourological procedures (44%). The most frequently performed procedures were uretero-cystoneostomy (49.2%) and Boari bladder flap (32.2%). Forty (67.8%) were open, and 19 (32.2%) were robot-assisted procedures. Major postoperative complications were recorded in seven (11.9%) patients. After a median follow-up of 42 months (interquartile range 12-24), treatment failure was observed in seven (11.9%) cases. Robot-assisted versus open procedures were associated with decreased estimated blood loss (p = 0.01), length of stay (p < 0.001) and treatment failure (0/19 vs. 7/36, p = 0.04). Conclusion In our series of iatrogenic ureteral lesions requiring reconstructive surgery, endourological procedures were the most frequent cause. Major postoperative complications were infrequent, and treatment failure rate was low. The robot-assisted approach was associated with improved perioperative outcomes and lower failure rate compared with open.
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Affiliation(s)
- Marta Rossanese
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of UrologyUniversity of MessinaMessinaItaly
| | | | - Riccardo Scalia
- Department of Surgical Oncological and Stomatological Sciences, Section of UrologyUniversity of PalermoPalermoItaly
| | - Luciano Macchione
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of UrologyUniversity of MessinaMessinaItaly
| | | | - Alchiede Simonato
- Department of Surgical Oncological and Stomatological Sciences, Section of UrologyUniversity of PalermoPalermoItaly
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Section of UrologyUniversity of MessinaMessinaItaly
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Alzahrani A, Al-Sharydah A, Alkhamis A, Alarifi M, AlMomen M, Alwarthan A, Aldamanhori R. Severe penile torsion of 180 degrees in an adult patient: a uro-radiological case report. J Med Life 2023; 16:1566-1570. [PMID: 38313174 PMCID: PMC10835563 DOI: 10.25122/jml-2023-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/12/2023] [Indexed: 02/06/2024] Open
Abstract
Penile torsion is the abnormal three-dimensional twisting of penile corporal bodies. It can be classified as mild, moderate, or severe, depending on the degree of torsion. Severe penile torsion (>90°) is a very rare condition, with an estimated incidence of 0.4%-1% among all penile torsion cases. Our patient was a 37-year-old man complaining of a 2-year history of lower urinary tract symptoms. These symptoms appeared after the patient sustained an iatrogenic injury during Foley catheter insertion. Physical examination incidentally revealed an obvious counterclockwise penile rotation of 180°. Several theories have been proposed to explain the etiology of penile torsion, including theories based on genetic factors, abnormal urethral development, and abnormal attachment of the dartos fascia to the skin. Penile torsion may be associated with other penile anomalies, including chordee, hypospadias, and epispadias; however, it is often detected as an isolated finding. Clinical examination is sufficient to confirm its diagnosis without the need for further imaging. While no standardized procedure has been indicated for all penile torsion cases, the severity of torsion and the presence of other anomalies determine the most suitable procedure. No reports on the imaging features of penile torsion (irrespective of the degree of torsion) are available. We present the first such report on the imaging features, including advanced magnetic resonance imaging findings, of a 180° penile torsion in an adult patient.
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Affiliation(s)
- Abdullah Alzahrani
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Al-Sharydah
- Diagnostic and Interventional Radiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulmalik Alkhamis
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mishal Alarifi
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed AlMomen
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Alwarthan
- Diagnostic and Interventional Radiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Reem Aldamanhori
- Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Matsumoto H, Hata J, Imuamura H, Yo S, Sasahira M, Misawa H, Oosawa M, Handa O, Umegami E, Shiotani A. Serial Changes in Intestinal Stenotic Stiffness in Patients with Crohn's Disease Treated with Biologics: A Pilot Study Using Ultrasound Shear Wave Elastography. Turk J Gastroenterol 2023; 34:1006-1013. [PMID: 37603302 PMCID: PMC10645284 DOI: 10.5152/tjg.2023.22768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/07/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND/AIMS Intestinal strictures represent an important serious complication of Crohn's disease. Shear wave elastography is a promising noninvasive ultrasound technique for assessing tissue stiffness. This study aimed to evaluate stiffness in the areas of intestinal stricture in patients with Crohn's disease using shear wave elastography and the changes in stiffness after biologics. MATERIALS AND METHODS We enrolled 21 Crohn's disease patients having intestinal stricture. The patients consisted of 3 groups, which were the infliximab naïve (n = 6) group, the ustekinumab naïve (n = 8), and the bio-switch from infliximab to ustekinumab (n = 7) group. Bowell wall thickness was examined by ultrasound sonography, and the stiffness of Crohn's disease stricture lesions was evaluated using Shear wave speed before and 1 year after anti-tumor necrosis factor-alpha antibody infliximab, anti-interleukin 12/23 antibody ustekinumab, and bio-switch from infliximab to ustekinumab. RESULTS Bowell wall thickness was significantly improved after infliximab, ustekinumab, and the bio-switch. However, shear wave speed indices only in the ustekinumab group significantly decreased after treatment (P = .028), but not in the other group. CONCLUSIONS Shear wave elastography might be a useful method to evaluate stiffness in the areas of intestinal stricture in patients with Crohn's disease treated with biologics. However, a prospective randomized study evaluating the development of obstruction after biological treatment is needed to validate the study findings.
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Affiliation(s)
- Hiroshi Matsumoto
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Jiro Hata
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Hiroshi Imuamura
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Shogen Yo
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Momoyo Sasahira
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Hiraku Misawa
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Motoyasu Oosawa
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Osamu Handa
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Eiji Umegami
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Akiko Shiotani
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
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Hristov B, Doykov D, Stanchev D, Kraev K, Uchikov P, Kostov G, Valova S, Tilkiyan E, Doykova K, Doykov M. Hepatico-Duodenal Fistula Following Iatrogenic Strasberg Type E4 Bile Duct Injury: A Case Report. Medicina (Kaunas) 2023; 59:1621. [PMID: 37763740 PMCID: PMC10537085 DOI: 10.3390/medicina59091621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Gallstone disease (GSD) is among the most common disorders worldwide. Gallstones are established in up to 15% of the general population. Laparoscopic cholecystectomy (LC) has become the "gold standard" for treatment of GSD but is associated with a higher rate of certain complications, namely, bile duct injury (BDI). Biliary fistulas (BF) are a common presentation of BDI (44.1% of all patients); however, they are mainly external. Post-cholecystectomy internal BF are exceedingly rare. CASE REPORT a 33-year Caucasian female was admitted with suspected BDI after LC. Strasberg type E4 BDI was established on endoscopic retrograde cholangiopancreatography (ERCP). Urgent laparotomy established biliary peritonitis. Delayed surgical reconstruction was planned and temporary external biliary drains were positioned in the right and left hepatic ducts. During follow-up, displacement of the drains occurred with subsequent evacuation of bile through the external fistula, which resolved spontaneously, without clinical and biochemical evidence of biliary obstruction or cholangitis. ERCP established bilio-duodenal fistula between the left hepatic duct (LHD) and duodenum, with a stricture at the level of the LHD. Endoscopic management was chosen with staged dilation and stenting of the fistulous tract over 18 months until fistula maturation and stricture resolution. One year after stent extraction, the patient remains symptom free. DISCUSSION Management of post-cholecystectomy BDI is challenging. The optimal approach is determined by the level and extent of ductal lesion defined according to different classifications (Strasberg, Bismuth, Hannover). Type E BDI are managed mainly surgically with a delayed surgical approach generally deemed preferable. Only three cases of choledocho-duodenal fistulas following LC BDI currently exist in the literature. Management is controversial, with expectant approach, surgical treatment (biliary reconstruction), or liver transplantation being described. Endoscopic treatment has not been described; however, in the current paper, it proved to be successful. More reports or larger case series are needed to confirm its applicability and effectiveness, especially in the long term.
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Affiliation(s)
- Bozhidar Hristov
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Daniel Doykov
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Desislav Stanchev
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Krasimir Kraev
- Department of Propedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Rheumatology Clinic, St. George University Hospital, 6000 Plovdiv, Bulgaria
| | - Petar Uchikov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Second Department of Surgery, St. George University Hospital, 4000 Plovdiv, Bulgaria
| | - Gancho Kostov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Department of Surgery, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Siyana Valova
- Section "Nephrology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Clinic of Nephrology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Eduard Tilkiyan
- Section "Nephrology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Clinic of Nephrology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Katya Doykova
- Department of Diagnostic Imaging, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Department of Diagnostic Imaging, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Mladen Doykov
- Department of Urology and General Medicine, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Clinic of Urology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
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Shipov A, Israeli I, Billet JP, Adam Y, Milgram J. Effect of Perineal Urethrostomy on the Length of the Urethra of the Cat: A Cadaveric Study. Animals (Basel) 2023; 13:2810. [PMID: 37760210 PMCID: PMC10525431 DOI: 10.3390/ani13182810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
Perineal urethrostomy in cats is indicated for urethral pathologies located distal to the bulbourethral glands. The description of the bulbourethral glands as the cranial landmark when performing a PU is based on the increased urethral diameter at this location, rather than on an anatomical limitation. This suggests that urethral pathologies cranial to the bulbourethral glands could potentially be treated with PU. At present, the extent to which the pelvic urethra can be mobilized is unknown. Characterization and quantification of the effect of PU on the pelvic urethra is required prior to attempting to define the location of the pelvic urethra, cranial to the bulbourethral glands, which can be exteriorized when performing a PU. Our aim was to characterize and quantify the effect of performing a PU on the location and length of the pelvic urethra. METHODS Ten male feline cadavers were used, and four markers were placed on the pelvic urethra via a ventral approach to the peritoneal and pelvic cavities. Two orthogonal radiographic views were acquired prior and subsequent to performing a PU. The distance of each marker to a predefined landmark/origin and the distances of the markers relative to each other were measured on all radiographs. RESULTS PU resulted in significant caudal translation of the markers relative to the predefined landmark on all radiographic views; however, PU did not result in a significant change in the distances between the markers. CONCLUSIONS Performing a PU results in caudal translation and minimal stretching of the mobilized pelvic urethra.
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Affiliation(s)
- Anna Shipov
- Veterinary Teaching Hospital-Koret School of Veterinary Medicine, Faculty of Agriculture Food & Environment, Hebrew University Jerusalem, Rehovot 7610001, Israel; (A.S.)
| | - Inbar Israeli
- Freelance Surgery, Tel Aviv 5800001, Israel
- Freelance Surgery, New York, NY 14925, USA
| | | | - Yoav Adam
- Veterinary Teaching Hospital-Koret School of Veterinary Medicine, Faculty of Agriculture Food & Environment, Hebrew University Jerusalem, Rehovot 7610001, Israel; (A.S.)
| | - Joshua Milgram
- Veterinary Teaching Hospital-Koret School of Veterinary Medicine, Faculty of Agriculture Food & Environment, Hebrew University Jerusalem, Rehovot 7610001, Israel; (A.S.)
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Canakis A, Sharaiha RZ. Radiofrequency ablation for pancreatobiliary disease: an updated review. Ann Gastroenterol 2023; 36:497-503. [PMID: 37664225 PMCID: PMC10433252 DOI: 10.20524/aog.2023.0828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/05/2023] [Indexed: 09/05/2023] Open
Abstract
Endoscopic radiofrequency ablation (RFA) has emerged as a minimally invasive treatment option in cases of malignant biliary obstruction, pancreatic cancer, and other pancreatic cystic neoplasms. Intraductal biliary RFA is safe, effective, and confers a survival advantage over stenting alone, where it should be used an adjunct to biliary stenting. Endoscopic ultrasound-guided RFA can also provide pancreatic cyst resolution in patients who are not ideal operative candidates. The aim of this review is to describe the endoscopic applications and associated outcomes of RFA.
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Affiliation(s)
- Andrew Canakis
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland (Andrew Canakis)
| | - Reem Z. Sharaiha
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York (Reem Z. Sharaiha), USA
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15
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Deger M, Cebeci OO, Ates T, Geyik S, Girgin R, Bozkurt O. Management Patterns of Male Urethral Stricture Disease among Urologists: What Do the Guidelines Say? What Do Urologists Do? ARCH ESP UROL 2023; 76:487-493. [PMID: 37867333 DOI: 10.56434/j.arch.esp.urol.20237607.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND The aim of the present study is to evaluate and analyze the daily clinical practice for male urethral stricture disease (MUSD) among urologists. METHODS Considering the latest guidelines on urethral stricture disease, a survey was developed regarding the various treatment options and preferences in different sites of male urethral stricture disease. The survey was sent to urologists via e-mail and phone application. RESULTS A total of 266 urologists completed the survey and were included in the final analysis. In regard to workplace, 62 (23.3%), 58 (21.8%), 71 (26.7%), and 75 (28.2%) respondents worked in university hospitals, training and research hospitals, state hospitals, and private practice hospitals, respectively. In regard to the diagnostic method used in male urethral strictures, 88.7% of the participants would choose uroflowmetry + postvoiding residual (UF + PVR), and 64.6% would choose retrograde urethrography (RUG). Direct vision internal urethrotomy (DVIU) was the most frequently chosen method in penile urethral strictures (PUS), being chosen by 72.9%. Direct vision anterior internal urethrotomy was the most common method for both ≤2 cm and >2 cm strictures, 63.1%, and 30.8%, respectively. The most preferred graft for augmentation urethroplasty was buccal mucosa (75.8%). Endoscopic incision/resection (transurethral resection (TUR)) is the most frequently applied treatment method for posterior urethral/vesicourethral anastomotic strictures (86.4%). CONCLUSIONS The present study clearly shows that most urologists still prefer DVIU and urethral dilatation to urethroplasty in MUSD, which contradicts current guidelines. Urologists should be encouraged to perform urethroplasty and/or refer patients to experienced centres for recurrent MUSD.
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Affiliation(s)
- Mutlu Deger
- Department of Urology, Faculty of Medicine, Çukurova University, 01330 Adana, Turkey
| | - Oguz Ozden Cebeci
- Department of Urology, Kocaeli Derince Traning and Research Hospital, Saglik Bilimleri University, 41200 Derince, Turkey
| | - Tunahan Ates
- Department of Urology, Faculty of Medicine, Çukurova University, 01330 Adana, Turkey
| | - Serdar Geyik
- Department of Urology, Faculty of Medicine, Aksaray University, 68200 Aksaray, Turkey
| | - Reha Girgin
- Department of Urology, Zonguldak Bulent Ecevit University, 67100 Zonguldak, Turkey
| | - Ozan Bozkurt
- Department of Urology, Dokuz Eylul University School of Medicine, 35390 Izmir, Turkey
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16
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Escobar D, Bushara O, Sun L, Liao J, Yang GY. High-Density IgG4+ Plasma Cells Infiltration Is Associated With Fibroplasia in Fibrostenotic Crohn's Disease. Int J Surg Pathol 2023; 31:1085-1092. [PMID: 36866568 DOI: 10.1177/10668969231152242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Transmural fibrosis and stricture formation are key pathogenic processes for Crohn's disease that underlies clinical refractoriness, resulting in severe morbidity. The mechanisms for fibroplasia in Crohn's are not fully elucidated. In this study, we identified a cohort of refractory Crohn's disease with surgically resected bowel specimens including cases with bowel stricture and age-/sex-matched refractory disease without bowel stricture. Via immunohistochemistry, density and distribution of IgG4+ plasma cells in resected cases were analyzed. The histologic severity of fibrosis and association with gross evidence of stricture formation and IgG4+ plasma cells were comprehensively analyzed. Our results showed that density of IgG4+ plasma cells/high-power field (IgG4+ PCs/HPF) was significantly associated with increasing histologic fibrosis score (15 IgG4+ PCs/HPF in specimens with fibrosis score 0 vs 31 IgG4+ PC/HPF in fibrosis score 2 and 3, P = .039). Patients with gross evidence of stricture had significantly higher fibrosis scores compared to those without gross evidence of stricture (P = .044). There was a trend that mean IgG4+ plasma cell count was higher in Crohn's disease with gross stricture formation (P = .26), although it did not reach statistical significance (likely due to multiple pathogenesis events involved in bowel stricture formation besides IgG4+ plasma cells; such as transmural fibrosis, muscular hypertrophy, transmural ulcer/scar formation, and muscular-neural dysfunction). Our findings indicate IgG4+ plasma cells are associated with increasing histologic fibrosis in Crohn's. Further research is needed to establish a role for IgG4+ plasma cells in fibroplasia with an eye toward potential medical therapies targeting IgG4+ plasma cells to prevent transmural fibrosis.
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Affiliation(s)
- David Escobar
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Omar Bushara
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Leyu Sun
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Jie Liao
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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Guliev BG, Komyakov BK, Avazkhanov JP, Abdurahmanov OS. [Laparoscopic substitution of the right ureter by appendix onlay]. Urologiia 2023:12-18. [PMID: 37850275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
INTRODUCTION In highly-selected patients with long narrowing of the middle and upper third of the right ureter, ureteroplasty with an appendix can be performed. In the literature, publications on the possibility of ureteroplasty onlay with a detubularized appendix have been appeared. AIM To study the results of laparoscopic ureteroplasty of the right ureter using appendix as onlay flap. MATERIALS AND METHODS In the Center of Urology of Mariinsky hospital, 5 patients (2 men and 3 women) with a long stricture of the middle or upper third of the right ureter underwent right-side ureteroplasty using appendix as onlay flap. The mean age of the patients was 42.5 years. In 4 cases, the stricture developed after ureteroscopy with lithotripsy, while in 1 patient, laparoscopic ureterolysis was previously performed. Three patients were admitted with nephrostomy tube, two with a ureteral stent. The average length of the stricture was 3.5 (2.8-5.2) cm. The ureteral stricture was visualized by laparoscopic access, dissected along its length and replaced with a detubularized appendix as onlay flap. RESULTS The average procedure time was 225 (180-260) min, the volume of blood loss was 160 (70-245) ml, and the hospital stay was 3.6 (3-7) days. There were no intraoperative complications. In the postoperative period, fever was observed in one patient, and ileus, which resolved spontaneously, developed in another patient. With an average follow-up period of 13.5 (6.2-24.4) months, the procedure was effective in all cases. The urodynamics of the upper urinary tract recovered completely in 3 patients and improved in 2 cases. Pain disappeared in all patients. It was possible to remove external and internal drainage in all cases. CONCLUSION In patients with long strictures of the middle and proximal parts of the right ureter, laparoscopic ureteroplasty using the appendix as onlay flap may be the method of choice. This procedure is less traumatic and has a low complication rate.
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Affiliation(s)
- B G Guliev
- Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - B K Komyakov
- Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - J P Avazkhanov
- Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - O Sh Abdurahmanov
- Department of Urology of FGBOU VO North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
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Simonovska N, Stefanovska VV, Babulovska A, Pereska Z, Jurukov I, Berat-Huseini A, Kostadinovski K, Naumovski K. Ingestion of corrosive substances and the endoscopic role in assessing the severity of caustic injury. Prz Gastroenterol 2023; 18:183-189. [PMID: 37538286 PMCID: PMC10395062 DOI: 10.5114/pg.2023.129415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/10/2022] [Indexed: 08/05/2023]
Abstract
Introduction The ingestion of caustic substances into the upper gastrointestinal tract is an unusual but potentially life-threatening problem. Aim To evaluate the most commonly ingested corrosive substances, and the endoscopic findings, complications, and final outcomes of caustic intake. Material and methods This cross-sectional study included 220 inpatient participants with corrosive poisonings during a 3-year period (2017-2019). Data from the national patient electronic system "My term" and from the "Poisoning information centre" at the University Clinic for Toxicology, Skopje were used. Demographic characteristics, type of corrosive substance, endoscopic findings by Kikendall classification, emerging complications, fatal outcome, and hospitalization were analysed. Data obtained were analysed with the SPSS software package, version 22.0 for Windows. Results During the period 2017-2019, out of 220 hospitalized cases with corrosive substance intake, 132 (60%) were with ingestion of acids, 19 (8.6%) with bases, 32 (14.6%) with bleaches, and 37 (16.8%) with other household products (p = 0.3469). The mean age of patients was 49.89 ±19.86 years. The most severe endoscopy findings (high-grade injury) were significantly more often associated with acid and base ingestion (p = 0.00001). Out of all strictures, 25 (64.1%) were on one location (either oesophagus or stomach), and 12 (30.8%) were on 2 locations. Conclusions Upper gastrointestinal endoscopy is very important procedure for rapid assessment of severity of caustic injury, early appropriate therapy, as well as the potential development of strictures. The obtained data are very important for the development of a national program for the prevention of corrosive poisoning in our country.
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Affiliation(s)
- Natasha Simonovska
- Clinical Centre, University Clinic for Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Vesna Velikj Stefanovska
- Institute of Epidemiology and Biostatistics, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Aleksandra Babulovska
- Clinical Centre, University Clinic for Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Zanina Pereska
- Clinical Centre, University Clinic for Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Irena Jurukov
- Clinical Centre, University Clinic for Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Afrodita Berat-Huseini
- Clinical Centre, University Clinic for Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Kristin Kostadinovski
- Clinical Centre, University Clinic for Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
| | - Kiril Naumovski
- Clinical Centre, University Clinic for Toxicology, Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, Republic of North Macedonia
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Kelly L, Shore J, Wright J, Patrick C, Holmes H. Economic evaluation of Optilume, a drug-coated balloon for recurrent anterior male urethral stricture. BJUI Compass 2023; 4:430-436. [PMID: 37334026 PMCID: PMC10268567 DOI: 10.1002/bco2.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/14/2023] [Accepted: 03/19/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives We aim to conduct an economic evaluation of the Optilume urethral drug-coated balloon (DCB) compared with endoscopic management for the treatment of recurrent anterior male urethral stricture in England. Patients and Methods A cohort Markov model was developed to estimate the costs and savings to the NHS over a 5-year time horizon of adopting Optilume for the treatment of anterior urethral male stricture versus current endoscopic standard of care. A scenario analysis was conducted which compared Optilume to urethroplasty. Probabilistic and deterministic sensitivity analyses were performed to estimate the impact of uncertainties in model parameters. Results When compared with current endoscopic standard of care Optilume resulted in an estimated cost saving of £2502 per patient if introduced in the NHS for the treatment of recurrent anterior male urethral stricture. In the scenario analysis, the use of Optilume compared with urethroplasty resulted in an estimated cost saving of £243. Results were robust to changes in individual input parameters as demonstrated in the deterministic sensitivity analyses, with the monthly probability of symptom recurrence associated with endoscopic management the only exception. Probabilistic sensitivity analysis results demonstrated that Optilume was cost saving in 93.4% of model iterations, when running 1000 iterations. Conclusion Our analysis suggests that the Optilume urethral DCB treatment can be a cost-saving alternative management option for the treatment of recurrent anterior male urethral stricture within the NHS in England.
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Affiliation(s)
- Laura Kelly
- York Health Economics Consortium, Enterprise House, Innovation WayUniversity of YorkYorkUK
| | - Judith Shore
- York Health Economics Consortium, Enterprise House, Innovation WayUniversity of YorkYorkUK
| | - James Wright
- Laborie Medical Technologies CORPPortsmouthNew HampshireUSA
| | - Craig Patrick
- Laborie Medical Technologies CORPPortsmouthNew HampshireUSA
| | - Hayden Holmes
- York Health Economics Consortium, Enterprise House, Innovation WayUniversity of YorkYorkUK
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Dandoy P, Louis E, Gast P, Poncin M, Seidel L, Loly JP. Factors associated with the efficacy and safety of endoscopic dilatation of symptomatic strictures in Crohn's disease: a retrospective cohort study. Scand J Gastroenterol 2023; 58:671-679. [PMID: 36533307 DOI: 10.1080/00365521.2022.2156808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/20/2022] [Accepted: 12/04/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Endoscopic balloon dilatation (EBD) is a standard treatment for intestinal strictures in Crohn's disease (CD). No evidence-based guidelines exist regarding the balloon diameter or the balloon pressure to be used, with recent studies suggesting the use of a smaller diameter than classically used. We sought to analyze the factors associated with safety and efficacy of EBD in CD strictures, particularly looking at balloon diameter and dilatation pressure. METHODS We conducted a monocentric retrospective study of patients who underwent EBD between 2005 and 2020. RESULTS Our endoscopy department performed EBD in 94 CD patients during the considered period. The mean size of balloon dilatation was 16 mm (±2.5; including 21 patients with balloon <14 mm) and the mean dilatation pressure was 5.3 atm (±1.5). No perforation was observed. Over a median follow-up of 5.6 years, the probability of being operated was 5.4% at 1 year and 10.4% at 3 years. Smaller height (HR = 0.90, p = 0.022) and a higher BMI (HR = 1.23, p = 0.014) were associated with the risk of operation. The probability of being operated or redilated was 30.1% at 1 year and 52.5% at 3 years. No factor was significantly associated with this risk. The size of the balloon had no impact on outcomes. CONCLUSION In this retrospective cohort, including a significant proportion of CD patients dilated with balloon <14 mm, no perforation was observed and the size of the balloon or the dilatation pressure had no impact on the risk of surgery or redilatation.
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Affiliation(s)
- Pierre Dandoy
- Department of Gastroenterology, CHU Liège University Hospital, Liège, Belgium
| | - Edouard Louis
- Department of Gastroenterology, CHU Liège University Hospital, Liège, Belgium
| | - Pierrette Gast
- Department of Gastroenterology, CHU Liège University Hospital, Liège, Belgium
| | - Maxime Poncin
- Department of Gastroenterology, CHU Liège University Hospital, Liège, Belgium
| | - Laurence Seidel
- Department of Clinical Research Support and Biostatistics, CHU Liège University Hospital, Liège, Belgium
| | - Jean-Philippe Loly
- Department of Gastroenterology, CHU Liège University Hospital, Liège, Belgium
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Tonyali S, Yilmaz M, Tzelves L, Emiliani E, De Coninck V, Keller EX, Miernik A. Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review. J Clin Med 2023; 12:jcm12103603. [PMID: 37240709 DOI: 10.3390/jcm12103603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords "ureteral stone", "ureteral calculus", "impacted stone", "ureteral stenosis", "ureteroscopic lithotripsy", "impacted calculus", and "ureteral strictures" singly or in combination. RESULTS After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures. CONCLUSION Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones.
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Affiliation(s)
- Senol Tonyali
- Department of Urology, Istanbul Faculty of Medicine, Istanbul University, 34452 Istanbul, Turkey
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
- European Association of Urology, Young Academic Urologist Endourology and Urolithiasis Working Party, NL-6803 Arnhem, The Netherlands
| | - Mehmet Yilmaz
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
| | - Lazaros Tzelves
- European Association of Urology, Young Academic Urologist Endourology and Urolithiasis Working Party, NL-6803 Arnhem, The Netherlands
- Department of Urology/Uro-Oncology, University College of London Hospitals (UCLH), London NW1 2BU, UK
| | - Esteban Emiliani
- European Association of Urology, Young Academic Urologist Endourology and Urolithiasis Working Party, NL-6803 Arnhem, The Netherlands
- Department of Urology, Fundacio Puigvert, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Vincent De Coninck
- European Association of Urology, Young Academic Urologist Endourology and Urolithiasis Working Party, NL-6803 Arnhem, The Netherlands
- Department of Urology, AZ Klina, 2930 Brasschaat, Belgium
| | - Etienne Xavier Keller
- European Association of Urology, Young Academic Urologist Endourology and Urolithiasis Working Party, NL-6803 Arnhem, The Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, 8006 Zurich, Switzerland
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany
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22
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Rodriguez K, Shargo R, Ekblad M, Sunkersett G, Karjoo S, Betensky M, Wilsey MJ. Endoscopic Assessment and Serial Balloon Dilatation in a Toddler With Dyskeratosis Congenita-Hoyeraal-Hreidarsson Syndrome Following Bone Marrow Transplant: A Case Report. JPGN Rep 2023; 4:e291. [PMID: 37200733 PMCID: PMC10187843 DOI: 10.1097/pg9.0000000000000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 12/12/2022] [Indexed: 05/20/2023]
Abstract
We report a 3-year-old patient with suspected oropharyngeal graft-versus-host disease (GVHD) who developed progressive dysphagia to solids and liquids. The patient has a history of Dyskeratosis Congenita-Hoyeraal-Hreidarsson Syndrome with associated bone marrow failure requiring a nonmyeloablative matched sibling hematopoietic stem cell transplant. Esophagram revealed significant narrowing in the cricopharyngeal region. Subsequent esophagoscopy showed a proximal, high-grade pinhole esophageal stricture that was very difficult to visualize and cannulate. High-grade esophageal strictures are uncommon in very young children with GVHD. We believe the patient's underlying Dyskeratosis Congenita-Hoyeraal-Hreidarsson Syndrome in the setting of inflammatory changes seen in GVHD following hematopoietic stem cell transplant set the stage for a high-grade esophageal obstruction. The patient's symptoms improved with serial endoscopic balloon dilation.
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Affiliation(s)
- Kurt Rodriguez
- From the Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Ryan Shargo
- University of South Florida, Reisterstown, MD
| | | | | | - Sara Karjoo
- From the Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Marisol Betensky
- From the Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
| | - Michael J. Wilsey
- From the Johns Hopkins All Children’s Hospital, Saint Petersburg, FL
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23
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Hohl B, Hoskins B, Ng K. A Child with an Esophageal Web Treated with Functional Lumen Imaging Probe. JPGN Rep 2023; 4:e304. [PMID: 37200730 PMCID: PMC10187835 DOI: 10.1097/pg9.0000000000000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 02/07/2023] [Indexed: 05/20/2023]
Abstract
A 14-month-old male presented to the emergency department with a 4-day history of vomiting after the intake of liquids or solids. During the admission, imaging studies revealed an esophageal web, a form of congenital esophageal stenosis. He was treated with a combination of Endoluminal Functional Lumen Imaging Probe (EndoFLIP) and controlled radial expansion (CRE) balloon dilation, followed by EndoFLIP and EsoFLIP dilation 1 month later. The patient's vomiting resolved after treatment, and he was able to gain weight. This report describes one of the first cases of applying EndoFLIP and EsoFLIP to treat an esophageal web in a pediatric patient.
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Affiliation(s)
- Brenna Hohl
- From the Department of Medicine, Campbell University School of Osteopathic Medicine, Lillington, NC
| | - Brett Hoskins
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kenneth Ng
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
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24
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Goßler C, Pfänder F, Haas M, Mayr R, Gierth M, Burger M, Rosenhammer B, Breyer J. Risk factors for bladder neck contracture after transurethral resection of the prostate. Prostate 2023. [PMID: 37089004 DOI: 10.1002/pros.24543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/06/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Transurethral resection of the prostate (TURP) is the most frequently used treatment of benign prostate hyperplasia with a prostate volume of <80 mL. A long-term complication is bladder neck contracture (BNC). The aim of the present study was to identify the risk factors for BNC formation after TURP. METHODS We conducted a retrospective analysis of all TURP primary procedures which were performed at one academic institution between 2013 and 2018. All patients were analyzed and compared with regard to postoperative formation of a BNC requiring further therapy. Uni- and multivariable logistic regression analyses (MVAs) were performed to identify possible risk factors for BNC development. RESULTS We included 1368 patients in this analysis. Out of these, 88 patients (6.4%) developed BNC requiring further surgical therapy. The following factors showed a statistically significant association with BNC development: smaller preoperative prostate volume (p = 0.001), lower resected prostate weight (p = 0.004), lower preoperative levels of prostate-specific antigen (PSA, p < 0.001), shorter duration of the surgery (p = 0.027), secondary transurethral intervention (due to urinary retention or gross hematuria) during inpatient stay (p = 0.018), positive (≥100 CFU/mL) preoperative urine culture (p = 0.010), and urethral stricture (US) formation requiring direct visual internal urethrotomy (DVIU) postoperatively after TURP (p < 0.001), in particular membranous (p = 0.046) and bulbar (p < 0.001) strictures. Preoperative antibiotic treatment showed a protective effect (p = 0.042). Histopathological findings of prostate cancer (PCA) in the resected prostate tissue were more frequent among patients who did not develop BNC (p = 0.049). On MVA, smaller preoperative prostate volume (p = 0.046), positive preoperative urine culture (p = 0.021), and US requiring DVIU after TURP (p < 0.001) were identified as independent predictors for BNC development. CONCLUSION BNC is a relevant long-term complication after TURP. In particular, patients with a smaller prostate should be thoroughly informed about this complication.
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Affiliation(s)
- Christopher Goßler
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Franziska Pfänder
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Maximilian Haas
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Roman Mayr
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Michael Gierth
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Bernd Rosenhammer
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Johannes Breyer
- Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
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Solitano V, Dal Buono A, Gabbiadini R, Wozny M, Repici A, Spinelli A, Vetrano S, Armuzzi A. Fibro-Stenosing Crohn's Disease: What Is New and What Is Next? J Clin Med 2023; 12:jcm12093052. [PMID: 37176493 PMCID: PMC10179180 DOI: 10.3390/jcm12093052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/03/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Fibro-stenosing Crohn's disease (CD) is a common disease presentation that leads to impaired quality of life and often requires endoscopic treatments or surgery. From a pathobiology perspective, the conventional view that intestinal fibro-stenosis is an irreversible condition has been disproved. Currently, there are no existing imaging techniques that can accurately quantify the amount of fibrosis within a stricture, and managing patients is challenging, requiring a multidisciplinary team. Novel therapies targeting different molecular components of the fibrotic pathways are increasing regarding other diseases outside the gut. However, a large gap between clinical need and the lack of anti-fibrotic agents in CD remains. This paper reviews the current state of pathobiology behind fibro-stenosing CD, provides an updated diagnostic and therapeutic approach, and finally, focuses on clinical trial endpoints and possible targets of anti-fibrotic therapies.
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Affiliation(s)
- Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Division of Gastroenterology, Department of Medicine, Western University, London, ON N6A 4V2, Canada
| | - Arianna Dal Buono
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Roberto Gabbiadini
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Marek Wozny
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Department of Endoscopy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Stefania Vetrano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
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26
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Merindol I, Vachon C, Juette T, Dunn M. Benign ureteral obstruction in cats: Outcome with medical management. J Vet Intern Med 2023; 37:1047-1058. [PMID: 37073892 DOI: 10.1111/jvim.16709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/01/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Limited information is available regarding the outcome of medical management (MM) of benign ureteral obstruction in cats (BUO). HYPOTHESIS Describe clinical characteristics and outcome of MM of BUO. ANIMALS Seventy-two client-owned cats with 103 obstructed kidneys. METHODS Medical records of cats diagnosed with BUO between 2010 and 2021 that received >72 hours of MM were retrospectively reviewed. Clinical data, treatment, and outcome were reviewed. Outcome was classified as success, partial success, or failure based on ultrasound findings. Factors associated with outcome were assessed. RESULTS Seventy-two cats with 103 obstructed kidneys were enrolled. The causes of obstruction were uroliths in 73% (75/103), strictures in 13.5% (14/103), and pyonephrosis in 13.5% (14/103) of affected kidneys. Median serum creatinine concentration at presentation was 4.01 mg/dL (range, 1.30-21.3 mg/dL). Outcome after MM was considered a success in 30% (31/103), partial success in 13% (13/103), and failure in 57% (59/103) of kidneys. Success was reported in 23% (17/75) of kidneys with uroliths, 50% (7/14) with pyonephrosis, and 50% (7/14) with strictures. Median time to a successful outcome was 16 days (range, 3-115 days). Distal and smaller uroliths (median length, 1.85 mm) were significantly associated with success (P = .05 and P = .01, respectively). Median survival times were 1188 days (range, 60-1700 days), 518 days (range, 7-1812 days), and 234 days (range, 4-3494 days) for success, partial success, and failure, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE We found a higher success rate for MM of BUO than previously reported. Smaller distal uroliths (<1-2 mm) were more likely to pass.
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Affiliation(s)
- Isabelle Merindol
- Department of Clinical Sciences, School of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Catherine Vachon
- Department of Clinical Sciences, School of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Tristan Juette
- Department of Clinical Sciences, School of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Marilyn Dunn
- Department of Clinical Sciences, School of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
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27
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Lynch KL, Benitez AJ, Godwin B, Klein J, Savant D, Wilkins BJ, Menard-Katcher C, Gluckman C, Falk GW, Muir A. The Slender Esophagus: Unrecognized Esophageal Narrowing in Eosinophilic Esophagitis. Clin Transl Gastroenterol 2023; 14:e00564. [PMID: 36603149 PMCID: PMC10132706 DOI: 10.14309/ctg.0000000000000564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/27/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Inflammation in eosinophilic esophagitis (EoE) often leads to esophageal strictures. Evaluating esophageal narrowing is clinically challenging. We evaluated esophageal distensibility as related to disease activity, fibrosis, and dysphagia. METHODS Adult patients with and without EoE underwent endoscopy and distensibility measurements. Histology, distensibility, and symptoms were analyzed. RESULTS Patients with EoE had significantly lower distensibilities than controls. We found a cohort with esophageal diameter under 15 mm despite lack of dysphagia. DISCUSSION This study raises concern that current assessments of fibrostenosis are suboptimal. We describe a cohort with unrecognized slender esophagus that were identified through impedance planimetry measurements. This tool provides additional information beyond symptomatic, histologic, and endoscopic assessments.
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Affiliation(s)
- Kristle L. Lynch
- Division of Gastroenterology and Hepatology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alain J. Benitez
- Division of Gastroenterology and Hepatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Bridget Godwin
- Division of Gastroenterology and Hepatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeremy Klein
- Division of Gastroenterology and Hepatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Deepika Savant
- Department of Pathology and Laboratory Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Benjamin J. Wilkins
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Calies Menard-Katcher
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Craig Gluckman
- Division of Gastroenterology and Hepatology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gary W. Falk
- Division of Gastroenterology and Hepatology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Amanda Muir
- Division of Gastroenterology and Hepatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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28
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Guliev BG, Komyakov BK, Avazkhanov ZP, Povago IA. [Ureteroplasty using onlay graft for long ureteral strictures]. Urologiia 2023:92-100. [PMID: 37401690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Full-text articles published in peer-reviewed journals dedicated to the results of onlay ureteroplasty using various materials, as well as monographs on surgical treatment of long ureteral strictures are presented in the article. Over the past decade, onlay technique for the treatment of long ureteral strictures using flaps or grafts on a vascular pedicle have been introduced. Experimental data on the results of onlay ureteroplasty using autologous vein or bladder mucosa, as well as the small intestine submucosa (SIS) have been published in the literature. Due to the availability and good survival rate, buccal and tongue mucosal flaps are widely recognized as the optimal graft for onlay ureteroplasty. There are also studies on the results of ureteroplasty using SIS or appendix graft onlay for the upper and middle ureteral strictures. A use of tissue-engineered flaps for ureteroplasty remains contradictory. Further research in this direction may allow to obtain optimal grafts for onlay ureteroplasty. However, oral mucosa or appendix are predominant materials, which are used for onlay ureteroplasty.
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Affiliation(s)
- B G Guliev
- Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - B K Komyakov
- Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - Zh P Avazkhanov
- Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
| | - I A Povago
- Department of urology of North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia
- Center of Urology with robot-assisted surgery of City Mariinsky hospital, Saint Petersburg, Russia
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29
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Ahn ST, Jo SB, Lee HS, Moon DG. Combining Transurethral Resection of Fibrous Tissue and Temporary Urethral Stent Insertion Is an Optimal Strategy for Minimally Invasive Treatment of Recurrent and Long Urethral Strictures. J Clin Med 2023; 12. [PMID: 36902528 DOI: 10.3390/jcm12051741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
This study investigated the optimal strategy for the treatment of chronic recurrent urethral strictures longer than 3 cm, using a temporary urethral stent. Between September 2011 and June 2021, 36 patients with chronic bulbomembranous urethral strictures underwent temporary urethral stent placement. Retrievable self-expandable polymer-coated bulbar urethral stents (BUSs) were placed in 21 patients (group A), and thermo-expandable nickel-titanium alloy urethral stents were placed in 15 patients (group M). Each group was subdivided into those with and without transurethral resection (TUR) of fibrotic scar tissue. The urethral patency rates at 1 year after stent removal were compared between the groups. The patients in group A showed a higher urethral patency maintenance rate at 1 year after stent removal than those in group M (81.0% vs. 40.0%, log rank test p = 0.012). Analysis of subgroups in which TUR was performed due to severe fibrotic scar, showed that the patients in group A showed a significantly higher patency rate than patients in group M (90.9% vs. 44.4%, log rank test p = 0.028). In the treatment of chronic urethral strictures with a long fibrotic scar, temporary BUS combined with TUR of fibrotic tissue seems to be the optimal minimally invasive treatment strategy.
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30
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Cooper JL, Rosentreter RE, Filyk A, Premji ZA, Shen H, Ingram R, Kaplan GG, Ma C, Novak K, Panaccione R, Seow CH, Rieder F, Raman M, Lu C. Nutritional interventions in adult fibrostenotic Crohn's disease: A systematic review. Front Nutr 2023; 10:1017382. [PMID: 36895272 PMCID: PMC9988909 DOI: 10.3389/fnut.2023.1017382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
Background Management of Crohn's disease (CD) using dietary interventions has become an area of increased research interest. There is a lack of specific research exploring if diet and nutrition interventions are beneficial in patients with strictures, as current dietary recommendations in fibrostenotic CD are often based on clinical judgment. The aim of this systematic review was to assess the impact of dietary interventions in fibrostenotic CD on medical and surgical outcomes. Methods A systematic search of MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and Cochrane Central Register of Controlled Trials (Ovid) was conducted. Studies reporting dietary interventions or nutritional factors in fibrostenotic CD were included. Outcomes for studies assessing dietary interventions such as enteral nutrition were evaluated as changes in (1) CD symptoms (CD Activity Index), (2) stricture parameters on diagnostic imaging, and (3) rates of surgical or medical intervention following dietary interventions. Results Five studies were included in this review. Three studies assessed exclusive enteral nutrition (EEN), one evaluated total parenteral nutrition (TPN), and one studied a liquid diet. All included studies evaluated symptoms as an outcome, while diagnostic imaging parameters and surgical outcomes in the studies were either absent or too heterogeneous to appraise improvement post dietary intervention. Included EEN studies displayed similar efficacy, with approximately 60% of patients having symptom improvement. The included TPN study also reported 75% of patients with symptom improvement, while the liquid diet did not. Conclusion Exclusive enteral nutrition and total parental nutrition may provide benefit for use as a dietary intervention for fibrostenotic CD. There remains a need for high-quality controlled trials which utilize standardized definitions of strictures.
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Affiliation(s)
- Jared L. Cooper
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ryan E. Rosentreter
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexis Filyk
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Hua Shen
- Department of Mathematics and Statistics, University of Calgary, Calgary, AB, Canada
| | - Richard Ingram
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gilaad G. Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Christopher Ma
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Kerri Novak
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cynthia H. Seow
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Maitreyi Raman
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Cathy Lu
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
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31
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Allocca M, Dal Buono A, D'Alessio S, Spaggiari P, Garlatti V, Spinelli A, Faita F, Danese S. Relationships Between Intestinal Ultrasound Parameters and Histopathologic Findings in a Prospective Cohort of Patients With Crohn's Disease Undergoing Surgery. J Ultrasound Med 2023. [PMID: 36744584 DOI: 10.1002/jum.16191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/24/2022] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Recognition of intestinal lesions with substantial fibrosis is strategic for optimal management of patients with Crohn's disease (CD). We aimed to assess the relationships between intestinal ultrasound parameters and histopathologic findings in a prospective cohort of patients with CD undergoing surgery. METHODS Seventeen consecutive adult CD patients with involvement of the terminal ileum or the sigmoid colon who underwent bowel resective surgeries were enrolled and performed intestinal ultrasound (IUS) within 30 days prior to surgery. Uni- and multivariable analyses were used to assess the relationships between IUS parameters and histopathological elements of lesions. RESULTS Sensitivity, specificity, accuracy, PPV and NPV (95% CI) of IUS in detecting stricturing and penetrating complications (surgical specimen as reference standard) were 93% (68-100), 86% (42-100), 91% (71-99), 93% (68-100) and 86% (42-100), and 78% (40-97), 92% (64-100), 86% (65-97), 88% (47-100) and 86% (57-98), respectively. Only the presence of hyperechogenic spiculates was statistically significantly associated with collagen content (b = 7.29, 95% CI = 1.88/12.69, P = .012), while only the presence of vascular signals at color Doppler (Limberg score 3 or 4) was significantly associated with active inflammation (OR = 10.0, 95% CI = 0.9/108.6, P = .037). There was a strong correlation between IUS and histological measurements of the wall thickness (r = 0.67, P = .01). CONCLUSIONS The presence of hyperechogenic spiculates was associated with the presence of fibrosis, while the presence of marked vascular signals was associated with the presence of inflammation. Wall thickness measured by IUS was reliable and reproducible in comparison with histological measurement.
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Affiliation(s)
- Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | | | | | | | | | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Francesco Faita
- Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
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Hanubal KS, Chheda NN, Dziegielewski PT. Neopharyngeal Stricture following Laryngectomy. Semin Plast Surg 2023; 37:31-38. [PMID: 36776807 PMCID: PMC9911225 DOI: 10.1055/s-0042-1759796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Stricture formation is a serious complication following pharyngeal reconstruction. These strictures can be life-threatening and can severely impact quality of life. In this article, the existing literature on surgical risk factors linked to neopharyngeal stricture formation is reviewed. Intraoperative preventative measures reconstructive surgeons should consider are also discussed. Finally, this article will describe the evaluation and management of pharyngoesophageal strictures, including the challenges and options when dealing with refractory strictures.
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Affiliation(s)
| | - Neil N. Chheda
- Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Peter T. Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida
- University of Florida Health Cancer Center, Gainesville, Florida
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Durakbasa CU, Ersoy F, Pirim A, Oskayli MC. Clinical outcome of endoscopic balloon dilatations employed in benign paediatric oesophageal pathologies. J Minim Access Surg 2023; 19:62-68. [PMID: 35915522 PMCID: PMC10034793 DOI: 10.4103/jmas.jmas_79_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Oesophageal dilatations can be done either by bougies or balloons for differing aetiologies in children. We investigated the efficacy and safety of endoscopic balloon dilatations (EBDs) employed by a single surgeon. Patients and Methods Relevant data over 12 years were retrospectively evaluated with an ethical committee approval. Results Ninety-seven children underwent 514 EBD with a median EBD of 3 (1-50). The primary diagnoses were oesophageal atresia (OA) in 51 children, corrosive ingestion in 21, peptic strictures in 13, achalasia in 8 and congenital oesophageal stenosis in 4. The balloon size varied between 3 and 30 mm. The EBD was successfully ended in 72 patients and unsuccessful in six patients. Six children are still under EBD and 13 are lost to follow-up. The overall success rate was 92%. The age at the time of first dilatation was the youngest in OA group followed by corrosive strictures. The balloon sizes differed regarding the age of the patients with larger balloons used as the patient age increased. The sizes of the balloons used at the first and the last EBD differed among diagnostic groups. The total number of dilatations or the time interval between the first and the last EBD dilatation did not show a statistically significant difference among groups. The anatomical type of OA or the height of corrosive stricture revealed no significant difference in any of the above parameters. A transmural oesophageal perforation occurred during 2 (0.4%) EBD sessions. Conclusions EBD is an effective mean in relieving paediatric oesophageal pathologies with a variety of aetiologies and has a low complication rate.
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Affiliation(s)
- Cigdem Ulukaya Durakbasa
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Goztepe Dr. Suleyman Yalcin Sehir Hospital, Istanbul, Turkey
| | - Furkan Ersoy
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Goztepe Dr. Suleyman Yalcin Sehir Hospital, Istanbul, Turkey
| | - Ahmet Pirim
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Goztepe Dr. Suleyman Yalcin Sehir Hospital, Istanbul, Turkey
| | - Meltem Caglar Oskayli
- Department of Pediatric Surgery, Istanbul Medeniyet University Faculty of Medicine, Goztepe Dr. Suleyman Yalcin Sehir Hospital, Istanbul, Turkey
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Starkov YG, Zamolodchikov RD, Vagapov AI, Ibragimov AS, Dzhantukhanova SV. [Complex endoscopic treatment of a patient with a large adenoma of the major duodenal papilla, choledocholithiasis and stricture of the common bile duct]. Khirurgiia (Mosk) 2023:115-121. [PMID: 37707341 DOI: 10.17116/hirurgia2023091115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Incidence of adenomas of the major duodenal papilla has increased in recent years due to widespread endoscopic screening. These adenomas require resection due to high risk of malignant transformation. Currently, minimally invasive endoscopic interventions are often considered as an alternative to surgical treatment. Combination of major duodenal papilla neoplasms with choledocholithiasis and bile duct strictures are particularly difficult for endoscopic treatment. A 56-year-old patient underwent complex endoscopic treatment for a large adenoma of the major duodenal papilla spreading to duodenal walls and distal segment of the common bile duct combined with choledocholithiasis and stricture of the common bile duct. The patient underwent complex minimally invasive treatment with endoscopic lithoextraction, fragment-by-fragment removal of the neoplasm with intra-ductal ablation of residual adenomatous tissue and subsequent staged biliary stenting for the stricture of the common bile duct, as well as stenting of the main pancreatic duct for prevention of pancreatitis. An integrated approach to the treatment of a patient with a large adenoma of the major duodenal papilla, choledocholithiasis and stricture of the common bile duct provided clinical success without complications and the need for long-term rehabilitation.
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Affiliation(s)
- Yu G Starkov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - R D Zamolodchikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A I Vagapov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A S Ibragimov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Gültekin M, Ceran S, Gültekin B. The comparison of alpha lipoic acid with methylprednisolone and sucralfate in subacute wound healing corrosive esophagus-induced rats: An experimental study. Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31:87-94. [PMID: 36926144 DOI: 10.5606/tgkdc.dergisi.2023.22694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/03/2022] [Indexed: 03/18/2023]
Abstract
Background This study aims to compare methylprednisolone frequently used in the therapeutic practices of corrosive esophagus burns, sucralfate, a protective material of mucosal surfaces, and alpha lipoic acid, the most potent antioxidant in a rat model. Methods A total of 40 female Sprague-Dawley rats were used in this study. The rats were equally divided into control, alpha lipoic acid, methylprednisolone, and sucralfate groups (n=10). A corrosive esophagus burn was created by using 10% pH:12 sodium hydroxide. No treatment was applied to the control group, and each group was given their own treatment. The treatment was continued regularly until the eighth day, when they were sacrificed. The corrosive esophagus burn lines were removed and tissue sections were stained with hematoxylin and eosin. Results The difference in ulceration in the group treated with alpha lipoic acid was significant, compared to the other groups. The most excellent complete epithelialization and complete re-epithelialization were observed in the alpha lipoic acid group. The difference between the groups was significant, with complete re-epithelialization being the lowest in the control and methylprednisolone groups (42.9% and 12.5%, respectively) and the highest in the alpha lipoic acid group (77.8%). In terms of ulceration and re-epithelialization, comparable values were found in the alpha lipoic acid group. The main difference was that the inflammation levels in the sucralfate group were lower and more favorable than the other groups in this period. The glutathione level was significantly higher in the alpha lipoic acid group and decreased the tissue hydroxyproline level. Conclusion Alpha lipoic acid reduces esophageal ulceration, severity and prevalence of inflammation, severity and prevalence of fibrosis, decreases tissue damage by increasing blood glutathione level, and also reduces stricture in corrosive esophagus burns in rats.
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Nagai K, Kuwatani M, Hirata K, Suda G, Hirata H, Takishin Y, Furukawa R, Kishi K, Yonemura H, Nozawa S, Sugiura R, Kawakubo K, Sakamoto N. Genetic Analyses of Cell-Free DNA in Pancreatic Juice or Bile for Diagnosing Pancreatic Duct and Biliary Tract Strictures. Diagnostics (Basel) 2022; 12:2704. [PMID: 36359547 PMCID: PMC9689036 DOI: 10.3390/diagnostics12112704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 08/30/2023] Open
Abstract
Poor prognosis of pancreaticobiliary malignancies is attributed to intrinsic biological aggressiveness and the lack of reliable methods for early diagnosis. This study aimed to evaluate the feasibility and availability of pancreatic juice- and bile-derived cell-free DNA (cfDNA) for diagnosing pancreaticobiliary strictures. From October 2020 to February 2022, pancreatic juice or bile was obtained from 50 patients with pancreaticobiliary strictures during endoscopic retrograde cholangiopancreatography. cfDNAs extracted from the samples were analyzed using next-generation sequencing and a cancer gene panel. The obtained cfDNAs, genetic data and clinical information were analyzed for diagnosis. cfDNA concentrations in pancreatic juice were higher in the intraductal papillary mucinous neoplasm group than in the other groups, whereas those in bile were similar in all groups. In pancreatic juice, the sensitivity, specificity and positive and negative predictive values of cfDNA analyses were 33%, 100%, 100% and 71.4%, respectively, whereas those of cytological analyses were 0%, 100%, 0% and 62.5%, respectively. In bile, those of cell-free DNA analyses were 53%, 75%, 89.5% and 28.6%, respectively, whereas those of cytological analyses were 19%, 100%, 100% and 16%, respectively. In conclusion, pancreatic juice- and bile-derived cfDNA is a novel liquid biopsy tool that can diagnose pancreaticobiliary strictures.
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Affiliation(s)
- Kosuke Nagai
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Masaki Kuwatani
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Koji Hirata
- Department of Gastroenterology and Hepatology, Hakodate Municipal Hospital, Hakodate 041-8680, Japan
| | - Goki Suda
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Hajime Hirata
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Yunosuke Takishin
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Ryutaro Furukawa
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Kazuma Kishi
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Hiroki Yonemura
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Shunichiro Nozawa
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Ryo Sugiura
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Kazumichi Kawakubo
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo 060-8648, Japan
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El Ouali S, Baker ME, Lyu R, Fletcher JG, Bruining DH, Holubar SD, Click B, Qazi T, Cohen BL, Rieder F. Validation of stricture length, duration and obstructive symptoms as predictors for intervention in ileal stricturing Crohn's disease. United European Gastroenterol J 2022; 10:958-972. [PMID: 36479841 PMCID: PMC9731662 DOI: 10.1002/ueg2.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/10/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Risk factors for intervention in terminal ileal (TI) stricturing Crohn's disease (CD) are poorly defined. Novel and rigorous definitions for TI strictures recently became available. OBJECTIVE We aimed to describe the rates of symptoms or need for endoscopic balloon dilation (EBD) or surgery as well as risk factors of progression in a well-defined stricturing CD cohort. METHODS Consecutive adult patients with non-penetrating stricturing TI CD, as defined by centrally-read magnetic resonance enterography CONSTRICT criteria, were separated into a derivation and validation cohort. Clinical and imaging characteristics were collected following prespecified scoring conventions. Primary outcome was a composite endpoint of EBD or surgery ("intervention"). Multivariable analysis was performed. RESULTS Eighty-six patients (48.8% female, median age 36 years) met selection criteria, 17.4% had prior EBD, 59.3% previously received biologics and 58.1% of strictures were anastomotic. Median follow-up was 63.4 [95% CI: 57, 68.9] months. In the derivation cohort, at 12 and 48 months, 26% and 45% of patients had intervention, respectively. Multivariable analysis showed obstructive symptoms (Hazard ratio [HR] 1.444; 95% CI 1.126-1.852), stricture duration (HR 0.974; 95% CI, 0.954-0.995) and length (HR 1.039; 95% CI, 1.011-1.069) predicted intervention. The concordance index for split-sample validation was 0.74 and 0.67, respectively. Biologics were not associated with intervention. An online risk calculator was constructed. CONCLUSION In patients with TI stricturing CD, 26% and 45% required intervention at 1 and 4 years. Obstructive symptoms, stricture duration and length were independent and validated predictors of the need for intervention. These findings are important for clinical practice and aid in the design of future trials for CD strictures.
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Affiliation(s)
- Sara El Ouali
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
- Digestive Disease InstituteCleveland ClinicAbu DhabiUAE
| | | | - Ruishen Lyu
- Department of Quantitative Health SciencesCleveland ClinicClevelandOhioUSA
| | | | - David H. Bruining
- Department of Gastroenterology & HepatologyMayo ClinicRochesterMinnesotaUSA
| | - Stefan D. Holubar
- Department of Colorectal SurgeryDigestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Benjamin Click
- Division of Gastroenterology and HepatologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Taha Qazi
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
- Digestive Disease InstituteCleveland ClinicAbu DhabiUAE
| | - Benjamin L. Cohen
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
- Digestive Disease InstituteCleveland ClinicAbu DhabiUAE
| | - Florian Rieder
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery InstituteCleveland Clinic FoundationClevelandOhioUSA
- Digestive Disease InstituteCleveland ClinicAbu DhabiUAE
- Department of Inflammation and ImmunityLerner Research InstituteCleveland Clinic FoundationClevelandOhioUSA
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Morsi A, Misra D. Technical Innovations to Reduce Complication Rates in Esophageal Atresia with Particular Reference to Long-term Outcomes: A Single Surgeon's Experience of 22 Years. J Indian Assoc Pediatr Surg 2022; 27:728-734. [PMID: 36714494 PMCID: PMC9878531 DOI: 10.4103/jiaps.jiaps_61_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/12/2022] [Accepted: 09/10/2022] [Indexed: 11/12/2022] Open
Abstract
Background Following esophageal atresia/tracheoesophageal fistula (EA/TEF) repair, the standard leak rate reported in the literature is 5%-10%, and stricture rate is 40%-72%. There is a global quest for surgical innovations to drive down these complication rates which can cause considerable morbidity. Methods A prospectively maintained database of the senior author's patients who had esophageal atresia repair from 1995 to 2016 was reviewed. Two distinct innovations were implemented: (1) adequate or generous mobilization of the lower esophageal pouch and (2) a 2-5 mm slit in distal esophagus to widen its circumference. Results Forty-three patients with EA/TEF were reviewed. Of those, 40 underwent primary repair. The median follow-up was 12.5 years (range 4-26 years). There were no anastomotic leaks and only 8 (20%) patients developed anastomotic strictures requiring dilations (1-5 dilations/patients). One patient (2.5%) had a recurrent fistula. One early mortality was recorded. At the latest follow-up, 35 (87.5%) patients had normal oral feeding, while 1 (2.5%) patient had occasional food sticking episodes. Four syndromic patients (10%) were on jejunal or gastrostomy feeding. Conclusion An adequate or generous mobilization of the distal esophageal pouch, together with a 2-5 mm slit in the distal esophagus, achieves a tension-free and wide anastomosis. All anastomoses eventually narrow, sometimes just a little, and starting on a higher scale with a small slit, helps. These seemingly minor innovations, when used together, contributed to a substantially lower complication rate sustained over a 22-year period - no leaks and only 20% stricture rate.
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Affiliation(s)
- Ahmed Morsi
- Department of Paediatric Surgery, The Royal London Hospital, London, England, UK
| | - Devesh Misra
- Department of Paediatric Surgery, The Royal London Hospital, London, England, UK
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Shen B. Interventional inflammatory bowel disease: endoscopic therapy of complications of Crohn's disease. Gastroenterol Rep (Oxf) 2022; 10:goac045. [PMID: 36120488 PMCID: PMC9472786 DOI: 10.1093/gastro/goac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 11/25/2022] Open
Abstract
Endoscopic therapy for inflammatory bowel diseases (IBD) or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease, bridging medical and surgical treatments. Currently, the main applications of interventional IBD are (i) strictures; (ii) fistulas and abscesses; (iii) bleeding lesions, bezoars, foreign bodies, and polyps; (iv) post-operative complications such as acute and chronic anastomotic leaks; and (v) colitis-associated neoplasia. The endoscopic treatment modalities include balloon dilation, stricturotomy, strictureplasty, fistulotomy, incision and drainage (of fistula and abscess), sinusotomy, septectomy, banding ligation, clipping, polypectomy, endoscopic mucosal resection, and endoscopic submucosal dissection. The field of interventional IBD is evolving with a better understanding of the underlying disease process, advances in endoscopic technology, and interest and proper training of next-generation IBD interventionalists.
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Affiliation(s)
- Bo Shen
- Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY, USA
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40
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Abstract
This paper provides an overview of the most common cause of salivary gland complaints presenting to the general dental practitioner, obstructive salivary gland disease (OSGD). It is important to be aware of the characteristic signs and symptoms to allow for appropriate management and onward referral.
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Affiliation(s)
- Kiran Beneng
- Consultant, Oral Surgery, Guy's Hospital, London, UK
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41
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Chandan S, Dhindsa BS, Khan SR, Deliwala S, Kassab LL, Mohan BP, Chandan OC, Loras C, Shen B, Kochhar GS. Endoscopic Stenting in Crohn's Disease-related Strictures: A Systematic Review and Meta-analysis of Outcomes. Inflamm Bowel Dis 2022:6650011. [PMID: 35880681 DOI: 10.1093/ibd/izac153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic progressive condition that is complicated by intestinal or colonic stricture in nearly 30% of cases within 10 years of the initial diagnosis. Endoscopic balloon dilation (EBD) is associated with a risk of perforations and recurrence rates of up to 60% at 5 years. Endoscopic stenting has been used as an alternative to EBD, but data on its safety and efficacy are limited. We conducted a systematic review and meta-analysis to assess the outcomes of endoscopic stenting in CD-related strictures. METHODS A systematic and detailed search was run in January 2022 with the assistance of a medical librarian for studies reporting on outcomes of endoscopic stenting in CD-related strictures. Meta-analysis was performed using random-effects model, and results were expressed in terms of pooled proportions along with relevant 95% confidence intervals (CIs). RESULTS Nine studies with 163 patients were included in the final analysis. Self-expanding metal stents (SEMS) including both partial and fully covered were used in 7 studies, whereas biodegradable stents were used in 2 studies. Pooled rate of clinical success and technical success was 60.9% (95% CI, 51.6-69.5; I2 = 13%) and 93% (95% CI, 87.3-96.3; I2 = 0%), respectively. Repeat stenting was needed in 9.6% of patients (95% CI, 5.3-16.7; I2 = 0%), whereas pooled rate of spontaneous stent migration was 43.9% (95% CI, 11.4-82.7; I2 = 88%). Pooled incidence of overall adverse events, proximal stent migration, perforation, and abdominal pain were 15.7%, 6.4%, 2.7%, and 17.9%, respectively. Mean follow-up period ranged from 3 months to 69 months. DISCUSSION Endoscopic stenting in CD-related strictures is a safe technique that can be performed with technical ease, albeit with a limited clinical success. Postprocedure abdominal pain and proximal stent migration are some of the common adverse events reported.
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Affiliation(s)
- Saurabh Chandan
- Department of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Banreet S Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shahab R Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Smit Deliwala
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
| | | | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
| | - Ojasvini C Chandan
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Childrens Hospital of Omaha, Omaha, NE, USA
| | - Carme Loras
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain
| | - Bo Shen
- Center for Ileal Pouch Disorders, Columbia University Irving Medical Center-New York Presbyterian Hospital, NY, USA
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
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Jia Y, Guo B, Zhang W, Li E, Zhang Q. Efficacy and safety of triamcinolone acetonide in the prevention of esophageal stricture after endoscopic submucosal dissection: a meta-analysis. Dis Esophagus 2022; 35:6640325. [PMID: 35829658 DOI: 10.1093/dote/doac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/27/2022] [Indexed: 12/11/2022]
Abstract
AIM The role of triamcinolone acetonide (TA) in the prevention of esophageal stricture is not well established. This meta-analysis aimed to evaluate its safety and efficacy for the prevention of esophageal stricture after endoscopic submucosal dissection (ESD). METHODS A comprehensive search was performed in electronic databases including PubMed, the Cochrane Library, Embase for possible controlled studies. The primary outcomes were stenosis rate and endoscopic balloon dilatation (EBD) sessions required, and secondary outcome included complications. Random effects were used to calculate the pooled outcome. Sensitivity analysis and publication bias were conducted to verify the robustness and reliability of the results. Results: Ten studies containing 499 patients were obtained. In the pooled analysis, statistical significance was found in triamcinolone acetonide injection reduced the incidence of stenosis (OR = 0.29, 95% CI [0.11, 0.80], P < 0.05) and the number of endoscopic balloon dilation (MD = -3.33, 95% CI [-4.15, -2.50], P < 0.0001) compared with control. Triamcinolone acetonide injection therapy did not increase the risk of complications (OR = -0.77%, CI [-1.62, 0.09], P = 0.08). Subgroup analysis indicated that the single injection of triamcinolone acetonide after endoscopic submucosal dissection significantly reduced the incidence of stenosis compared with without any prophylaxis. Different concentrations and single session volume of triamcinolone acetonide reduced the incidence of stenosis. It also showed that the dose according to the size of the lesion was more effective than the fixed dose in preventing esophageal stricture. Conclusion: Triamcinolone acetonide injection can reduce the incidence of stricture formation as well as the need for EBD sessions without increasing complications.
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Affiliation(s)
- Yuting Jia
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
| | - Bin Guo
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
| | - Wenbin Zhang
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
| | - Erfeng Li
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
| | - Quanmao Zhang
- Department of Endoscopy Center, Shanxi Province Cancer Hospital, Taiyuan, China
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Axelrad JE, Faye A, Slaughter JC, Harpaz N, Itzkowitz SH, Shah SC. Colorectal Strictures in Patients With Inflammatory Bowel Disease Do Not Independently Predict Colorectal Neoplasia. Inflamm Bowel Dis 2022; 28:855-861. [PMID: 34319381 PMCID: PMC9165549 DOI: 10.1093/ibd/izab177] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colorectal strictures have been considered independent risk factors for neoplasia in patients with inflammatory bowel disease (IBD). We examined the association between colorectal stricture and subsequent risk of colorectal neoplasia (CRN) in patients with IBD colitis undergoing colonoscopic surveillance. METHODS We conducted a retrospective cohort analysis of patients with IBD colitis enrolled in colonoscopic surveillance for CRN at an academic medical center between 2005 and 2017. Inclusion criteria were IBD involving the colon for ≥8 years (or any duration with primary sclerosing cholangitis [PSC]) undergoing surveillance. Exclusion criteria were advanced CRN (ACRN; colorectal cancer [CRC] or high-grade dysplasia [HGD]) prior to or at enrollment, prior colectomy, or limited (<30%) disease extent or proctitis. Multivariable logistic and Cox regression analysis estimated the association between colorectal stricture on the index colonoscopy and ACRN, CRN (indefinite dysplasia, low-grade dysplasia, HGD, CRC), or colectomy. RESULTS Among 789 patients with IBD undergoing CRC surveillance, 72 (9%; 70 with Crohn's colitis) had a colorectal stricture on index colonoscopy. There was no significant difference in the frequency of ACRN or requirement for colectomy between patients with vs without a colorectal stricture (P > .05). Colorectal stricture was not associated with subsequent ACRN (adjusted odds ratio [aOR], 1.41; 95% CI, 0.49-4.07), CRN (aOR, 1.15; 95% CI, 0.51-2.58), or colectomy (aOR, 1.10; 95% CI, 0.65-1.84). CONCLUSIONS In this analysis of patients with IBD colitis undergoing CRN surveillance, the presence of a colorectal stricture was not independently associated with risk of ACRN or colectomy. Multicenter, prospective studies are needed to confirm these findings, particularly in patients with ulcerative colitis-associated colorectal stricture.
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Affiliation(s)
- Jordan E Axelrad
- Division of Gastroenterology, NYU Grossman School of Medicine, New York, NY, USA
| | - Adam Faye
- Division of Gastroenterology, NYU Grossman School of Medicine, New York, NY, USA
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Noam Harpaz
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven H Itzkowitz
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shailja C Shah
- Section of Gastroenterology, Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA
- Division of Gastroenterology, University of California, San Diego, La Jolla, CA, USA
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Joshi P, Bandini M, Kulkarni SB. Mucosal-sparing augmented non-transected anastomotic (MsANTA) urethroplasty: a step forward in ANTA urethroplasty. BJU Int 2022; 130:133-136. [PMID: 35403358 PMCID: PMC9322537 DOI: 10.1111/bju.15734] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/15/2022] [Accepted: 03/27/2022] [Indexed: 12/02/2022]
Abstract
The surgical advancement of urethral reconstruction is a rapidly moving field. In the last decade, the technique for bulbar urethroplasty has evolved towards less invasive approaches with minimal transection and more tissue sparing in order to increase the patency rate. In this study, we provide a step forward in the augmented non‐transected anastomotic (ANTA) urethroplasty proposed in 2012, with a true mucosa‐sparing modification of the technique. In detail, the bulbar urethral lumen is approached with either a ventral or dorsal urethrotomy. Differently from previous techniques, the native urethral mucosa is neither transected nor resected but is reconstructed with a direct mucosa‐to‐mucosa anastomosis. This allows a complete sparing of communicant vessels that come from the corpus spongiosum to the urethral mucosa. The technique aims to preserve the native vascularity of the urethral mucosa by enlarging the native urethral plate with a direct anastomosis at the level of the stricture, and without the need for resection. In our hands the technique was easy and reproducible, and it carried promising results in the preliminary cohort where it was applied.
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Affiliation(s)
- Pankaj Joshi
- Kulkarni Reconstructive Urology Center, Pune, India
| | - Marco Bandini
- Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
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Lawrence LS, Heider A, Singer AAM, Neef HC, Adler J. Granulomas in Diagnostic Biopsies Associated With High Risk of Crohn's Complications-But May Be Preventable. Inflamm Bowel Dis 2022; 28:523-530. [PMID: 33999198 DOI: 10.1093/ibd/izab109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Granulomatous intestinal inflammation may be associated with aggressive Crohn's disease (CD) behavior. However, this has not been confirmed, and it is unknown if associated disease complications are preventable. METHODS This is a retrospective cohort of patients younger than 21 years at CD diagnosis (November 1, 2005 to November 11, 2015). Clinical information was abstracted, including dates of starting medications and the timing of perianal fistula or stricture development, if any. Diagnostic pathology reports were reviewed, and a subset of biopsy slides were evaluated by a blinded pathologist. Patients were excluded if perianal fistula or stricture developed within 30 days after CD diagnosis. Medications were included in analyses only if started >90 days before development of perianal fistula or stricture. RESULTS In total, 198 patients were included. Half (54%) had granulomas at diagnosis. Granulomas were associated with a greater than 3-fold increased risk of perianal fistula (hazard ration [HR] = 3.24; 95% confidence interval CI], 1.40-7.48). Immunomodulator and anti-tumor necrosis factor-α (anti-TNF) therapy were associated with 90% (HR, = 0.10; 95% CI, 0.03-0.42) and 98% (HR, = 0.02; 95% CI, 0.01-0.10) reduced risk of perianal fistula, respectively. Patients with granulomatous inflammation preferentially responded to anti-TNF therapy with reduced risk of perianal fistula. The presence of granulomas was not associated with risk of stricture. Immunomodulator and anti-TNF therapy were associated with 96% (HR, = 0.04; 95% CI, 0.01-0.22) and 94% (HR, = 0.06; 95% CI, 0.02-0.20) reduced risk of stricture, respectively. CONCLUSIONS Granulomas are associated with increased risk of perianal fistula but not stricture. Steroid sparing therapies seem to reduce the risk of both perianal fistula and stricture. For those with granulomas, anti-TNF-α therapy greatly reduced the risk of perianal fistula development, whereas immunomodulators did not.
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Affiliation(s)
- Lindsey S Lawrence
- Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan, United States
| | - Amer Heider
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Andrew A M Singer
- Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan, United States
| | - Haley C Neef
- Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan, United States
| | - Jeremy Adler
- Division of Pediatric Gastroenterology, C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan, United States.,Susan B. Meister Child Health Evaluation and Research Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, United States
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Vieujean S, Loly JP, Boutaffala L, Meunier P, Reenaers C, Briquet A, Lechanteur C, Baudoux E, Beguin Y, Louis E. Mesenchymal Stem Cell Injection in Crohn's Disease Strictures: A Phase I-II Clinical Study. J Crohns Colitis 2022; 16:506-510. [PMID: 34473270 DOI: 10.1093/ecco-jcc/jjab154] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIM Mesenchymal stem cells [MSCs] have anti-inflammatory and anti-fibrotic properties and could be a potential therapy for Crohn's disease [CD] strictures. In this phase I-II pilot trial, we assessed safety and efficacy of local MSC injection to treat CD strictures. METHODS CD patients with a short [less than 5 cm in length] non-passable stricture accessible by ileocolonoscopy were included. Allogenic bone-marrow derived MSCs were injected in the four quadrants of the stricture. Adverse events and clinical scores were evaluated at each follow-up visit and endoscopy and magnetic resonance enterography were performed at baseline, Week [W]12 and W48. The main judgement criterion for efficacy was the complete [defined by the ability to pass the ileocolonoscope] or partial [defined by a diameter increase] resolution of the stricture at W12. Second efficacy criteria included assessment of the stricture at W48 and evolution of clinical scores at W12 and W48. RESULTS We performed 11 MSC injections in 10 CD patients [three primary and seven anastomotic strictures; one stricture injected twice]. MSC injections were well tolerated but four hospitalisations for occlusion were reported. At W12, five patients presented a complete or partial resolution of the stricture [two complete and three partial]. Seven patients were re-evaluated at W48 [one dilated, one operated, and one lost to follow-up] and four patients had a complete resolution. The evolution of clinical scores between W0, W12, and W48 was not statistically significant. CONCLUSIONS MSCs injection in CD stricture was well tolerated and may offer a benefit.
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Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Jean-Philippe Loly
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Layla Boutaffala
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Paul Meunier
- Department of Radiology, University Hospital CHU of Liège, Liège, Belgium
| | - Catherine Reenaers
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Alexandra Briquet
- Laboratory of Cell and Gene Therapy [LTCG], University Hospital CHU of Liège, Liège, Belgium
| | - Chantal Lechanteur
- Laboratory of Cell and Gene Therapy [LTCG], University Hospital CHU of Liège, Liège, Belgium
| | - Etienne Baudoux
- Laboratory of Cell and Gene Therapy [LTCG], University Hospital CHU of Liège, Liège, Belgium
| | - Yves Beguin
- Laboratory of Cell and Gene Therapy [LTCG], University Hospital CHU of Liège, Liège, Belgium.,Department of Hematology, University Hospital CHU of Liège and University of Liège, Liège, Belgium
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
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Takeda T, Kishi M, Takatsu N, Takada Y, Beppu T, Miyaoka M, Hisabe T, Ueki T, Arima H, Hirai F, Yao K. Long-term outcomes of endoscopic balloon dilation for intestinal strictures in patients with Crohn's disease during maintenance treatment with anti-tumor necrosis factor alpha antibodies. Dig Endosc 2022; 34:517-525. [PMID: 34185921 DOI: 10.1111/den.14073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Efficacy of endoscopic balloon dilation (EBD) for intestinal strictures in patients with Crohn's disease (CD) receiving anti-tumor necrosis factor alpha antibodies (anti-TNF) as maintenance therapy is unclear. We investigated the long-term efficacy and safety of EBD for intestinal strictures in patients with CD receiving anti-TNF. METHODS We retrospectively analyzed data from patients with CD who received anti-TNF as maintenance therapy from 2008 to 2017, underwent EBD, and were followed up for ≥6 months. The primary endpoint was the cumulative surgery-free rate. The main secondary endpoints were technical success, repeat EBD rate, risk factors affecting surgical outcomes, and safety. RESULTS Seventy-two patients with CD were assessed. The median observation period after EBD was 50 months. The technical success rate was 67%. The 3- and 5-year cumulative surgery-free rates were 81.1% and 73.5%, respectively. The repeat EBD rate was 74%. Multivariable analyses showed that risk factors affecting surgical outcomes were age at disease onset ≤16 years (hazard ratio 3.69; 95% confidence interval 1.36-10.01; P = 0.011). Serious complications requiring surgery developed in three patients. CONCLUSIONS Endoscopic balloon dilation was an effective and safe short-term treatment and a useful long-term treatment for CD patients with intestinal strictures receiving anti-TNF as maintenance therapy.
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Affiliation(s)
- Teruyuki Takeda
- IBD Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Masahiro Kishi
- IBD Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Noritaka Takatsu
- IBD Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Yasumichi Takada
- IBD Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Tsuyoshi Beppu
- IBD Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Masaki Miyaoka
- Departments of, Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Takashi Hisabe
- Department of, Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toshiharu Ueki
- Department of, Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Hisatomi Arima
- Departments of, Preventive Medicine and Public Health, Fukuoka University Facility of Medicine, Fukuoka, Japan
| | - Fumihito Hirai
- IBD Center, Fukuoka University Chikushi Hospital, Fukuoka, Japan
- Department of, Gastroenterology, Fukuoka University Facility of Medicine, Fukuoka, Japan
| | - Kenshi Yao
- Departments of, Endoscopy, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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Iozsa DA, Spătaru RI, Tomescu LF, Stiru O, Gherghiceanu F, Furtunescu F, Radavoi D, Bacalbasa N, Balescu I, Tulin A. Pediatric esophageal stenoses: Challenges and new surgical device promoting tension-free esophageal anastomosis. Exp Ther Med 2022; 23:220. [PMID: 35222697 DOI: 10.3892/etm.2022.11144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/25/2021] [Indexed: 11/05/2022] Open
Abstract
Esophageal stenoses of childhood have a broad spectrum of underlying causes. Their treatment is usually minimally invasive by endoscopic means, but sometimes surgery is necessary in refractory cases. Techniques employed in the surgical treatment of esophageal strictures include resection of the stenotic esophageal segment or esophageal substitution procedures. Esophageal anastomosis has always been a challenge in pediatric surgery. Anastomosis complications are linked to anatomical, biological and technical aspects. Mechanical tension between esophageal ends is an important cause of complications including anastomotic leaks or dehiscence. Eleven cases of esophageal stenoses, surgically treated in the Pediatric Surgery Department of Emergency Clinical Hospital for Children 'Marie S. Curie' by a single team in 5 years, were included in the present study. The results showed that, the main causes of esophageal stenosis were represented by corrosive esophageal injury in five cases, complications of esophageal atresia repair in three cases, congenital esophageal stenosis in two cases and chemotherapy-induced esophageal necrosis in acute lymphoblastic leukemia treatment in one case. The authors also designed and presented a device facilitating esophageal anastomosis under tension. Its principle involved temporary absorption of tension at secure points of the two esophageal pouches and reallocating it in equal amounts following anastomosis while decreasing any stretch-related tissue trauma. In conclusion, this auxiliary tool is beneficial for esophageal anastomosis; however, the standard steps of the esophageal anastomosis procedure should still be considered when necessary.
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Collins MH, Alexander ES, Martin LJ, Grotjan TM, Mukkada VA, Sheil A, Abonia JP, Putnam PE, Rothenberg ME. Acquired Esophageal Strictures in Children: Morphometric and Immunohistochemical Analyses. Pediatr Dev Pathol 2022; 25:124-133. [PMID: 34515576 PMCID: PMC10102868 DOI: 10.1177/10935266211041086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Esophageal strictures (ES) in children are not well characterized pathologically. We report unique histopathologic analyses of resected acquired ES and control esophagi (CE). METHODS Muscle layer thicknesses were measured in intact well-oriented areas; inflammatory cells were counted in the most inflamed high power field (hpf). Sections were stained with relevant antibodies. Results were expressed as median, lower and upper quartiles. Wilcoxon Rank Sums non-parametric test was used to compare groups; P ≤ 0.05 was considered significant. RESULTS All ES (N = 10) showed focal replacement of lamina propria, muscularis mucosa and submucosa by actin+ fibers emanating from muscularis propria. Compared to CE (N = 8), ES displayed significantly thickened muscularis mucosa and propria, and increased mast cells (tryptase- and chymase-positive), and eosinophils in muscle layers (all P ≤ 0.01). Matrix proteins periostin and fibronectin were identified in the muscle layers of CE, and in the extracellular matrix in areas of disrupted architecture in ES. CONCLUSIONS Compared to CE, acquired ES in children show significant structural alterations, including obliterative muscularization, inflammatory cell mural infiltrates, and extracellular matrix protein deposits. Therapies targeting connective tissue expansion, mast cells, eosinophils and inflammation may be beneficial to treat ES.
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Affiliation(s)
- Margaret H Collins
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eileen S Alexander
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tommie M Grotjan
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Sheil
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Juan P Abonia
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Philip E Putnam
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Kwapisz L, Bruining DH, Inoue A, Lee YS, Edwards PK, Holmes DR, Carter RE, Siegelman J, Fletcher JG. CT or MR Enterography to Assess Response During Vedolizumab Therapy for Small Bowel Crohn's Disease. Crohns Colitis 360 2022; 4:otac003. [PMID: 36777547 PMCID: PMC9802241 DOI: 10.1093/crocol/otac003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background To describe response to therapy of small bowel (SB) Crohn's disease (CD) at CT or MR enterography (CTE/MRE) in patients on vedolizumab. Methods Patients with SB CD who underwent CTE/MRE exams greater than 12 months apart on vedolizumab therapy were included. Length (in cm) and inflammation severity (EMBARK score) of inflamed SB segments were assessed. Changes in inflammation length of 3.4 cm or greater or inflammation severity of 2 EMBARK points or greater was categorized as response or progression, as appropriate, with development of newly inflamed segments, strictures, or penetrating complications also indicating progression. Patients not meeting the criteria for response or progression were categorized as having stable disease. Results Of 36 SB CD patients, the large majority had prior surgery (86%; 31), anti-TNF use (92%; 33), and internal penetrating (78%; 28) disease. Thirty-two patients had paired baseline and follow-up CTE/MRE exams without interval surgery, with clinical response observed in 24/32 (75%). Based on imaging response criteria, 22% (7/32; 95% CI: 9%-40%) had response, 50% (16/32; 95% CI: 32%-68%) were stable, and 28% (9/32; 95% CI: 14%-47%) had disease progression. Fifty-six percent of (18/32; 95% CI: 38%-74%) patients had clinical improvement with response or stable disease by imaging. Patients with stable disease had shorter median baseline lengths of SB inflammation (P = .012). Proportion of patients with colonic inflammation, perianal disease, or penetrating complications did not change. Conclusions Most patients on vedolizumab for over 12 months demonstrated response or stable SB disease when using objective cross-sectional radiologic imaging criteria using CTE/MRE.
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Affiliation(s)
- Lukasz Kwapisz
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
| | - David H Bruining
- Divison of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Akitoshi Inoue
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yong S Lee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David R Holmes
- Biomedical Imaging Resource, Mayo Clinic, Rochester, Minnesota, USA
| | - Rickey E Carter
- Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA,Address correspondence to: Joel G. Fletcher, MD, Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA ()
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