Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pa...Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pathology.A positive histological diagnosis is always preferred prior to high risk hepatobiliary surgery,or to inform other types of therapy.Endoscopic retrograde cholangiopancreato-graphy with brushings has low sensitivity and despite significant improvements in instruments there is still an unacceptably high false negative rate.Other methods such as endoscopic ultrasound and cholangioscopy have improved diagnostic quality.In this review we explore the techniques available to aid accurate diagnosis of indeterminate biliary strictures and obtain accurate histology to facilitate clinical management.展开更多
BACKGROUND Solid organ transplantation is a life-saving intervention for end-stage organ disease.Post-transplant diabetes mellitus(PTDM)is a common complication in solid organ transplant recipients,and significantly c...BACKGROUND Solid organ transplantation is a life-saving intervention for end-stage organ disease.Post-transplant diabetes mellitus(PTDM)is a common complication in solid organ transplant recipients,and significantly compromises long-term survival beyond a year.AIM To perform a systematic review and meta-analysis to estimate incidence of PTDM and compare the effects of the 3 major immunosuppressants on incidence of PTDM.METHODS Two hundred and six eligible studies identified 75595 patients on Tacrolimus,51242 on Cyclosporine and 3020 on Sirolimus.Random effects meta-analyses was used to calculate incidence.RESULTS Network meta-analysis estimated the overall risk of developing PTDM was higher with tacrolimus(OR=1.495%CI:1.0–2.0)and sirolimus(OR=1.8;95%CI:1.5–2.2)than with Cyclosporine.The overall incidence of PTDM at years 2-3 was 17%for kidney,19%for liver and 22%for heart.The risk factors for PTDM most frequently identified in the primary studies were age,body mass index,hepatitis C,and African American descent.CONCLUSION Tacrolimus tends to exhibit higher diabetogenicity in the short-term(2-3 years post-transplant),whereas sirolimus exhibits higher diabetogenicity in the longterm(5-10 years post-transplant).This study will aid clinicians in recognition of risk factors for PTDM and encourage careful evaluation of the risk/benefit of different immunosuppressant regimens in transplant recipients.展开更多
Hepatorenal fibrocystic diseases are inherited disorders,characterized by developmental abnormalities and fibrocystic degeneration of the portobiliary system and kidneys^([1]).They are part of a larger group of disord...Hepatorenal fibrocystic diseases are inherited disorders,characterized by developmental abnormalities and fibrocystic degeneration of the portobiliary system and kidneys^([1]).They are part of a larger group of disorders referred to as"ciliopathies"which affect 1 in 1000 people.Polycystic kidney disease is the most common kidney manifestation,while others include nephronophthisis,glomerulocystic disease and cystic dysplasia.Hepatic manifesta-tions include Caroli’s disease,congenital hepatic fibrosis and poly-cystic liver disease.展开更多
Background and aims:Primary sclerosing cholangitis(PSC)often co-exists with inflammatory bowel disease(IBD)and together they are associated with increased risk of complications,including cancer(hepatobiliary,colorecta...Background and aims:Primary sclerosing cholangitis(PSC)often co-exists with inflammatory bowel disease(IBD)and together they are associated with increased risk of complications,including cancer(hepatobiliary,colorectal,gallbladder)and death.Guidelines for follow up and surveillance vary,but our local guidelines advise annual surveillance with magnetic resonance cholangiopancreatography(MRCP),colonoscopy and ultrasound(US)(6 monthly if cirrhotic).We aimed to assess the quality of care in our PSC-IBD patients,including adherence to local surveillance guidelines,and resultant detection of complications,before and after the introduction of an integrated PSC and IBD out-patient service.Methods:Data on management of PSC-IBD patients was collected retrospectively before,and prospectively following,the introduction of an integrated service.Descriptive comparisons of diagnoses,adherence to planned surveillance and outcomes were made between cohorts pre-and post-service redesign.Results:Prior to the service re-design there was significant variability in care and poor adherence to guidelines.Introduction of an integrated PSC-IBD service led to 89 referrals with possible PSC-IBD at 36 months after service re-design.Detailed review led to appropriate identification of 68 PSC-IBD patients.There was significant improvement in surveillance with annual colonoscopy in 90%,MRI/MRCP in 81%,US in 35%,compared to 55%,55%and 7%respectively in the baseline cohort.This translated to diagnosis and appropriate treatment of colonic dysplasia in 4 patients,colorectal cancer(CRC)in 4 patients and cholangiocarcinoma(CCA)in 2 patients.Conclusion:Establishment of an integrated out-patient service for PSC-IBD patients results in better compliance with guidelines,effective detection of complications,and appropriate management.展开更多
文摘Indeterminate biliary strictures pose a significant diagnostic dilemma for gastroenterologists.Despite advances in endoscopic techniques and instruments,it is difficult to differentiate between benign and malignant pathology.A positive histological diagnosis is always preferred prior to high risk hepatobiliary surgery,or to inform other types of therapy.Endoscopic retrograde cholangiopancreato-graphy with brushings has low sensitivity and despite significant improvements in instruments there is still an unacceptably high false negative rate.Other methods such as endoscopic ultrasound and cholangioscopy have improved diagnostic quality.In this review we explore the techniques available to aid accurate diagnosis of indeterminate biliary strictures and obtain accurate histology to facilitate clinical management.
文摘BACKGROUND Solid organ transplantation is a life-saving intervention for end-stage organ disease.Post-transplant diabetes mellitus(PTDM)is a common complication in solid organ transplant recipients,and significantly compromises long-term survival beyond a year.AIM To perform a systematic review and meta-analysis to estimate incidence of PTDM and compare the effects of the 3 major immunosuppressants on incidence of PTDM.METHODS Two hundred and six eligible studies identified 75595 patients on Tacrolimus,51242 on Cyclosporine and 3020 on Sirolimus.Random effects meta-analyses was used to calculate incidence.RESULTS Network meta-analysis estimated the overall risk of developing PTDM was higher with tacrolimus(OR=1.495%CI:1.0–2.0)and sirolimus(OR=1.8;95%CI:1.5–2.2)than with Cyclosporine.The overall incidence of PTDM at years 2-3 was 17%for kidney,19%for liver and 22%for heart.The risk factors for PTDM most frequently identified in the primary studies were age,body mass index,hepatitis C,and African American descent.CONCLUSION Tacrolimus tends to exhibit higher diabetogenicity in the short-term(2-3 years post-transplant),whereas sirolimus exhibits higher diabetogenicity in the longterm(5-10 years post-transplant).This study will aid clinicians in recognition of risk factors for PTDM and encourage careful evaluation of the risk/benefit of different immunosuppressant regimens in transplant recipients.
文摘Hepatorenal fibrocystic diseases are inherited disorders,characterized by developmental abnormalities and fibrocystic degeneration of the portobiliary system and kidneys^([1]).They are part of a larger group of disorders referred to as"ciliopathies"which affect 1 in 1000 people.Polycystic kidney disease is the most common kidney manifestation,while others include nephronophthisis,glomerulocystic disease and cystic dysplasia.Hepatic manifesta-tions include Caroli’s disease,congenital hepatic fibrosis and poly-cystic liver disease.
文摘Background and aims:Primary sclerosing cholangitis(PSC)often co-exists with inflammatory bowel disease(IBD)and together they are associated with increased risk of complications,including cancer(hepatobiliary,colorectal,gallbladder)and death.Guidelines for follow up and surveillance vary,but our local guidelines advise annual surveillance with magnetic resonance cholangiopancreatography(MRCP),colonoscopy and ultrasound(US)(6 monthly if cirrhotic).We aimed to assess the quality of care in our PSC-IBD patients,including adherence to local surveillance guidelines,and resultant detection of complications,before and after the introduction of an integrated PSC and IBD out-patient service.Methods:Data on management of PSC-IBD patients was collected retrospectively before,and prospectively following,the introduction of an integrated service.Descriptive comparisons of diagnoses,adherence to planned surveillance and outcomes were made between cohorts pre-and post-service redesign.Results:Prior to the service re-design there was significant variability in care and poor adherence to guidelines.Introduction of an integrated PSC-IBD service led to 89 referrals with possible PSC-IBD at 36 months after service re-design.Detailed review led to appropriate identification of 68 PSC-IBD patients.There was significant improvement in surveillance with annual colonoscopy in 90%,MRI/MRCP in 81%,US in 35%,compared to 55%,55%and 7%respectively in the baseline cohort.This translated to diagnosis and appropriate treatment of colonic dysplasia in 4 patients,colorectal cancer(CRC)in 4 patients and cholangiocarcinoma(CCA)in 2 patients.Conclusion:Establishment of an integrated out-patient service for PSC-IBD patients results in better compliance with guidelines,effective detection of complications,and appropriate management.
