Endoscopic luminal stenting(ELS)represents a minimally invasive option for the management of malignant obstruction along the gastrointestinal tract.Previous studies have shown that ELS can provide rapid relief of symp...Endoscopic luminal stenting(ELS)represents a minimally invasive option for the management of malignant obstruction along the gastrointestinal tract.Previous studies have shown that ELS can provide rapid relief of symptoms related to esophageal,gastric,small intestinal,colorectal,biliary,and pancreatic neoplastic strictures without compromising cancer patients’overall safety.As a result,in both palliative and neoadjuvant settings,ELS has largely surpassed radiotherapy and surgery as a first-line treatment modality.Following the abovementioned success,the indications for ELS have gradually expanded.To date,ELS is widely used in clinical practice by well-trained endoscopists in managing a wide variety of diseases and complications,such as relieving non-neoplastic obstructions,sealing iatrogenic and non-iatrogenic perforations,closing fistulae and treating post-sphincterotomy bleeding.The abovementioned development would not have been achieved without corresponding advances and innovations in stent technology.However,the technological landscape changes rapidly,making clinicians’adaptation to new technologies a real challenge.In our mini-review article,by systematically reviewing the relevant literature,we discuss current developments in ELS with regard to stent design,accessories,techniques,and applications,expanding the research basis that was set by previous studies and highlighting areas that need to be further investigated.展开更多
Increased thrombotic potential within the liver sinusoids due to local endothelial production of von Willebrand factor antigen macromolecules could represent an additional therapeutic target of portal hypertension in ...Increased thrombotic potential within the liver sinusoids due to local endothelial production of von Willebrand factor antigen macromolecules could represent an additional therapeutic target of portal hypertension in patients with cirrhosis. In this case, anti-inflammatory and antithrombotic drugs could modulate portal pressure by preventing the formation of intrahepatic platelet-induced microthrombi.展开更多
Objectives: To identify local resource use such as pharmaceutical treatment, medical follow-up, and patient hospitalization and estimate the budget impact of simeprevir (SMV) plus pegylated interferon (P)/ribavirin (R...Objectives: To identify local resource use such as pharmaceutical treatment, medical follow-up, and patient hospitalization and estimate the budget impact of simeprevir (SMV) plus pegylated interferon (P)/ribavirin (R) as a treatment option in the early stages of the disease in Greece. Methods: A budget impact tool was developed with a two-year time horizon, which estimated the impact on the Social Insurance Funds (SIFs) of introducing SMV + PR in the management of the early disease stages. Total direct and indirect costs were estimated for each of the following health states: non-cirrhotic chronic Hepatitis C (and within that by fibrosis stage), compensated cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma. Data gaps on treatment algorithms, resource use and productivity losses were covered via an expert panel of eight leading hepatologists. Epidemiology data were taken from the published literature. Unit costs were obtained from the Ministry of Health and SIFs. The perspective was that of the SIF and the cost base year was 2015. Results: The total (direct and indirect) cost per patient per year (excluding cost of antiviral treatment) was estimated at €647, €703, €5,753, €16,313 and €37,237 for non-cirrhotic CHC, compensated cirrhosis, decompensated cirrhosis, HCC and liver transplantation, respectively. The budget impact analysis showed that adding SMV to PR in the early stages of the disease would lead to an increase in the cost of antiviral treatment by €2.03 million. Conclusions: Costs of managing CHC increase dramatically with disease severity. SMV + PR for naive patients at early disease stages has a significant but manageable budget impact, and could prevent high costs in advanced stages.展开更多
文摘Endoscopic luminal stenting(ELS)represents a minimally invasive option for the management of malignant obstruction along the gastrointestinal tract.Previous studies have shown that ELS can provide rapid relief of symptoms related to esophageal,gastric,small intestinal,colorectal,biliary,and pancreatic neoplastic strictures without compromising cancer patients’overall safety.As a result,in both palliative and neoadjuvant settings,ELS has largely surpassed radiotherapy and surgery as a first-line treatment modality.Following the abovementioned success,the indications for ELS have gradually expanded.To date,ELS is widely used in clinical practice by well-trained endoscopists in managing a wide variety of diseases and complications,such as relieving non-neoplastic obstructions,sealing iatrogenic and non-iatrogenic perforations,closing fistulae and treating post-sphincterotomy bleeding.The abovementioned development would not have been achieved without corresponding advances and innovations in stent technology.However,the technological landscape changes rapidly,making clinicians’adaptation to new technologies a real challenge.In our mini-review article,by systematically reviewing the relevant literature,we discuss current developments in ELS with regard to stent design,accessories,techniques,and applications,expanding the research basis that was set by previous studies and highlighting areas that need to be further investigated.
文摘Increased thrombotic potential within the liver sinusoids due to local endothelial production of von Willebrand factor antigen macromolecules could represent an additional therapeutic target of portal hypertension in patients with cirrhosis. In this case, anti-inflammatory and antithrombotic drugs could modulate portal pressure by preventing the formation of intrahepatic platelet-induced microthrombi.
文摘Objectives: To identify local resource use such as pharmaceutical treatment, medical follow-up, and patient hospitalization and estimate the budget impact of simeprevir (SMV) plus pegylated interferon (P)/ribavirin (R) as a treatment option in the early stages of the disease in Greece. Methods: A budget impact tool was developed with a two-year time horizon, which estimated the impact on the Social Insurance Funds (SIFs) of introducing SMV + PR in the management of the early disease stages. Total direct and indirect costs were estimated for each of the following health states: non-cirrhotic chronic Hepatitis C (and within that by fibrosis stage), compensated cirrhosis, decompensated cirrhosis, and hepatocellular carcinoma. Data gaps on treatment algorithms, resource use and productivity losses were covered via an expert panel of eight leading hepatologists. Epidemiology data were taken from the published literature. Unit costs were obtained from the Ministry of Health and SIFs. The perspective was that of the SIF and the cost base year was 2015. Results: The total (direct and indirect) cost per patient per year (excluding cost of antiviral treatment) was estimated at €647, €703, €5,753, €16,313 and €37,237 for non-cirrhotic CHC, compensated cirrhosis, decompensated cirrhosis, HCC and liver transplantation, respectively. The budget impact analysis showed that adding SMV to PR in the early stages of the disease would lead to an increase in the cost of antiviral treatment by €2.03 million. Conclusions: Costs of managing CHC increase dramatically with disease severity. SMV + PR for naive patients at early disease stages has a significant but manageable budget impact, and could prevent high costs in advanced stages.
