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Development and validation of a multiparametric magnetic resonance imaging-based nomogram for predicting feasibility of sphincter-preserving surgery in mid-low rectal cancer 认领 引用
1
作者 Juan Wang Tianjing Chang +18 位作者 Lili Tang Qingyang Li Zhaoya Gao Qingkun Gao HaopengHong Zhibo Hou Wanlan Li Yaping Li Ye Han Wenyu Wu Hongwei Wang Wenhan Feng Manli Na Jianjie Wang Mingchuan Yu Bin Zhang Ming Li Yingshi Sun Jin Gu 《Chinese Journal of Cancer Research》 SCIE CAS CSCD 2026年第2期268-284,共17页
Objective:Although distance from the inferior tumor edge to the anal verge(DTAV)is a key predictor for sphincter-preserving surgery(SPS)in mid-low rectal cancer,its utility is limited in the"decision-gray zone&qu... Objective:Although distance from the inferior tumor edge to the anal verge(DTAV)is a key predictor for sphincter-preserving surgery(SPS)in mid-low rectal cancer,its utility is limited in the"decision-gray zone"(DTAV,3-8 cm).Therefore,this study aimed to develop and validate a multiparametric magnetic resonance imaging-based nomogram for individualized preoperative prediction of SPS feasibility.Methods:This dual-center retrospective study included 335 patients with rectal adenocarcinoma(DTAV 3-8 cm).Patients were divided into training(n=263)and external validation(n=72)cohorts,and predictors were identified using multivariate logistic regression analysis.Model discrimination was assessed using area under the receiver operating curve(AUC)and calibration via the Hosmer-Lemeshow test.Subgroup analyses were performed across DTAV strata.Results:Four independent predictors were identified:larger DTAV[odds ratio(OR)=5.00,P<0.001)],larger pubococcygeal overlap distance(PCOD)(OR=1.08,P=0.001),transverse diameter of mesorectal fat(TMS)(OR=1.07,P=0.017),and subcutaneous adipose tissue thickness(SAT)(OR=0.94,P=0.016).The Sphincter Preservation Assessment in Rectal Cancer(SPARC)nomogram achieved an AUC of 0.928[95%confidence interval(95%CI):0.8900.956]in the training cohort,outperforming DTAV alone(AUC=0.884,P=0.031)and maintaining an AUC of 0.916(95%CI:0.827-0.969)in external validation.Subgroup analysis showed notably improved predictions in the 5-8 cm DTAV subgroup.Decision curve analysis demonstrated a pronounced net clinical benefit across a wide range of threshold probabilities.Interobserver agreement was excellent(intraclass correlation coefficient,0.8900.997).Conclusions:The SPARC nomogram reliably predicted SPS feasibility by integrating tumor location with pelvic anatomy and fat distribution.This provides valuable and evidence-based preoperative guidance,especially within the DTAV 3-8 cm gray zone. 展开更多
关键词 Magnetic resonance imaging nomogram rectal cancer pelvimetry sphincter preservation
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Metformin enhances external urethral sphincter integrity and restores continence via AMPK activation in a rat model of stress urinary incontinence 认领 引用
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作者 Yuting Xu Xuhong Li +5 位作者 Alvaro Munoz Li Jiang Lihua Huang Yanhua Zhou Liping Zhu Youbo Yang 《Animal Models and Experimental Medicine》 CAS CSCD 2026年第4期796-808,共13页
Background:Stress urinary incontinence(SUI)is primarily caused by structural and functional damage to the external urethral sphincter(EUS).In previous studies,metformin,a known AMP-activated protein kinase(AMPK)activa... Background:Stress urinary incontinence(SUI)is primarily caused by structural and functional damage to the external urethral sphincter(EUS).In previous studies,metformin,a known AMP-activated protein kinase(AMPK)activator,has shown repair effects after skeletal muscle injury.This study explored its therapeutic effect and molecular mechanisms in SUI associated with EUS injury.Methods:The SUI model was established by double vaginal dilation.Rats were assigned to sham,vehicle-treated,or metformin-treated(200 mg/kg/day,oral)groups.Urodynamic testing was performed after 7 and 14 days.Subsequently,EUS tissues were isolated for histological(hematoxylin and eosin[H&E],Masson's),apoptotic(TUNEL),ultrastructural(transmission electron microscopy[TEM]),and molecular analyses.Finally,C2C12 myotubes cells were treated with varying concentrations of metformin to evaluate the expression of phosphorylated AMPK(p-AMPK)and MYH1/2,which are markers of skeletal muscle fiber type and regeneration.Results:Abdominal leak point pressure(ALPP)and bladder leak point pressure(BLPP)decreased after double vaginal dilation,suggesting that SUI was established.After treatment for 7 and 14 days,respectively,metformin significantly increased ALPP and BLPP(p0.05).Masson's staining and TEM revealed that metformin improved disorganized EUS architecture.Further,Western blot analysis demonstrated that metformin increased the expression of MYH1/2 and p-AMPK in vivo and in vitro.Meanwhile TUNEL assay showed that metformin treatment reduced apoptotic cells in the EUS from SUI rats.Conclusions:These results indicate that metformin enhances EUS repair to improve SUI via activating the AMPK signaling pathway.These findings provide new insights into therapeutic strategies for SUI. 展开更多
关键词 AMPK signaling pathway external urethral sphincter metformin treatment stress urinary incontinence
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Sutured rectal lift for obstructed defecation:Mesh-free sphincterpreserving transanal technique for Oxford gradeⅡ-Ⅲprolapse 认领 引用
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作者 Claudio Eduardo Pagano Sonia Sarnari +4 位作者 Umberto Favetta Roberto Picheo Fabrizio Gambarini Angelo Guttadauro Michele Schiano di Visconte 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第3期305-314,共10页
BACKGROUND Obstructed defecation syndrome(ODS)frequently results from an internal rectal prolapse,which disrupts the rectal axis and impairs evacuation.Resectional transanal operations can remove redundant tissue,but ... BACKGROUND Obstructed defecation syndrome(ODS)frequently results from an internal rectal prolapse,which disrupts the rectal axis and impairs evacuation.Resectional transanal operations can remove redundant tissue,but fail to restore structural support,whereas abdominal mesh rectopexy involves prosthetic materials and has a higher operative burden.The sutured rectal lift(SuReL)was developed as a reconstructive,non-resective,and mesh-free transanal technique to restore rectal suspension while preserving continence in patients with ODS secondary to internal prolapse.AIM To describe the rationale,indications,and step-by-step operative technique of SuReL for Oxford gradeⅡ-Ⅲinternal rectal prolapse causing obstructed defecation.METHODS SuReL was performed using the Sylarum®transanal access device.The rectal wall was addressed sequentially in six circumferential sectors(11,1,9,3,7,and 5 o’clock).In each sector,a triphasic suture sequence with a barbed 0/0 monofilament(Filbloc®)was placed:(1)A mucosa-submucosa pass;(2)A deeper pass including the muscularis layer at the same level;and(3)A third pass 3 mm caudally,forming a semiloop for suspension.Cranial plications advanced distally to the upper limit of the prolapse.A deep circumferential reinforcement layer with a 2/0 Assuplus®monofilament consolidated the lift.RESULTS The procedure standardizes the reconstructive phase through sector-based rotation,allowing symmetric traction and full-thickness suspension without resection.Operative pearls consist of maintaining uniform exposure,ensuring precise semiloop depth for tension control,and verifying lumen patency with saline irrigation.Key technical advantages include the absence of stapling devices or prosthetic materials,minimal bleeding,a short operative time,and preservation of mucosal sensitivity.Postoperative recovery is typically rapid with early mobilization and minimal discomfort.CONCLUSION SuReL represents a technically reproducible and standardized approach for the treatment of internal rectal prolapse.This preclinical study demonstrated feasibility and mechanical consistency using anatomical simulators,while the clinical efficacy and physiological benefits remain to be validated in prospective trials. 展开更多
关键词 Obstructed defecation syndrome Internal rectal prolapse Transanal surgery Sphincter preservation Rectal suspension Surgical standardization
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A canine model of reversible urethral sphincter insufficiency 认领 引用
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作者 Pourya Shokri Shahin Tabatabaei +3 位作者 Seyed Amir Mohsen Ziaee Mir Sepehr Pedram Mohammad Mehdi Dehghan Nasser Shakhssalim 《Animal Models and Experimental Medicine》 CAS CSCD 2025年第2期372-377,共6页
This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study... This study developed an animal model with internal and external urethral sphincter insufficiency by bypassing the sphincter without major damage so that the animal under study can return to normal life after the study.There is a need for a reliable,applicable,and reproducible animal model for studying urinary incontinency disease due to incorrect sphincter function.Seven adult male dogs were used for this study.The urethral sphincter was bypassed by inserting a catheter between the bladder neck and the distal sphincter.The animals'physical condition was closely monitored for 9 weeks,and standard urodynamic and radiologic studies were performed before and 1–2 months after surgery.The animals were killed at 9 weeks after surgery for pathological assessment.Catheter placement caused complete incontinence in the animal,with urodynamic assessments indicating that the animal was unable to control urination and radiological assessments indicating an empty bladder with a residual volume of 50±10 cc.Tissue analysis did not show significant histological damage and inflammation.The study shows that by bypassing the urethral sphincter,which is a reliable and reproducible method,an animal model of urinary incontinence can be developed,which can be used in various studies such as assessing the adequacy of artificial sphincter function.The animals under study did not have any permanent defect,so they were able to return to their normal life. 展开更多
关键词 animal model external urethral sphincter internal urethral sphincter urinary incontinence
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Anal sphincter reconstruction for fecal incontinence:Techniques,outcomes,and future directions 认领 引用
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作者 Hai-Liang Li Hao-Ran Zhang +3 位作者 Yuan Wu Kai-Qiang He Tian-Jie Chen Jing Wang 《World Journal of Gastrointestinal Surgery》 SCIE 2025年第11期131-143,共13页
Fecal incontinence,a debilitating condition that significantly impairs quality of life,affects 2%-21%of adults worldwide.For patients whose structural defects are unresponsive to conservative therapies,sphincter recon... Fecal incontinence,a debilitating condition that significantly impairs quality of life,affects 2%-21%of adults worldwide.For patients whose structural defects are unresponsive to conservative therapies,sphincter reconstruction remains the primary treatment approach.Although traditional surgical techniques effectively restore anatomy in the short term,their long-term efficacy is constrained by progressive muscle atrophy and fibrotic scarring.In complex cases,alternative interventions,including dynamic gracilis or gluteus maximus transposition and artificial sphincter implantation,offer therapeutic options yet are associated with increased surgical risks and high complication rates.Emerging therapies such as regenerative medicine and neuromodulatory approaches have potential,although further rigorous clinical validation is needed to establish standardized protocols.Optimizing fecal incontinence management necessitates precise patient stratification,multidisciplinary collaboration,and the development of individualized treatment algorithms.Advancements in this field depend on large-scale clinical trials and comprehensive long-term outcome assessments to improve therapeutic efficacy and patient-centered care. 展开更多
关键词 Fecal incontinence Sphincter reconstruction Overlapping sphincteroplasty Sacral nerve stimulation Regenerative medicine
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Peroral endoscopic myotomy for achalasia and patients with normal lower-esophageal-sphincter integrated relaxation pressure:A propensity-score-matched retrospective study 认领 引用 被引量：1
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作者 Xiao Li Xiao-Bin Zhang +9 位作者 Jia-Kang Shao Bo Zhang Long-Song Li Rui-Qing Zhu Jia-Le Zou Jia-Feng Wang Xin Zhao Qing-Zhen Wu Ning-Li Chai En-Qiang Linghu 《World Journal of Gastroenterology》 SCIE CAS 2025年第12期27-36,共10页
BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the cli... BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.AIM To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure(LES-IRP).METHODS The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.A total of 481 patients who underwent preoperative high-resolution manometry(HRM)at our hospital were ultimately included in this research.According to the HRM results,the patients were divided into two groups:71 patients were included in the normal LES-IRP group(LES-IRP<15 mmHg)and 410 patients were included in the increased LES-IRP group(LES-IRP≥15 mmHg).Clinical characteristics,procedure-related parameters,adverse events,and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.RESULTS Among the 481 patients included in our study,209 were males and 272 were females,with a mean age of 44.2 years.All patients underwent POEM without severe adverse events.The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0(P=0.132),respectively,decreasing to 1.0 and 1.0 post-treatment(P=0.572).The clinical success rate of the normal LES-IRP group was 87.3%(62/71),and that of the increased LES-IRP group was 91.2%(374/410)(P=0.298).Reflux symptoms were measured by the GerdQ questionnaire,and the percentages of patients with GerdQ scores≥9 in the normal LES-IRP and increased LES-IRP groups were 8.5%and 10.7%,respectively(P=0.711).After matching,the rates of clinical success and the rates of GerdQ score≥9 were not significantly different between the two groups.CONCLUSION Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP.In addition,in patients with normal LES-IRP,compared with those with increased LES-IRP,POEM was not associated with a greater incidence of reflux symptoms. 展开更多
关键词 Peroral endoscopic myotomy Achalasia Lower esophageal sphincter integrated relaxation pressure Safety Efficacy
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Risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery 认领 引用 被引量：1
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作者 Jia-Rui Liu Jin Zhang Xiang-Long Duan 《World Journal of Gastrointestinal Surgery》 SCIE 2025年第3期240-248,共9页
BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is c... BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is crucial for guiding clinical decision-making and optimising preoperative patient evaluation.AIM To examine the risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery.METHODS A retrospective analysis of the demographics,preoperative and intraoperative data,and pathological findings of 179 patients with rectal cancer who underwent laparoscopic radical rectal cancer surgery at our hospital between January 2022 and December 2023 was conducted.These clinical data were compared between two groups:Patients with sphincter preservation and those without,categorised as the sphincter-preserved and sphincter-unpreserved groups,respectively.RESULTS Of the 179 patients analysed,150 were in the sphincter-preserved group and 29 were in the sphincter-unpreserved group.Tumour height was significantly greater in the sphincter-preserved group compared to the sphincter-unpreserved group.Conversely,elevated levels of carcinoembryonic antigen,carbohydrate antigen 19-9,and plasma D-dimer were significantly higher in the sphincter-unpreserved group.Significant differences were also observed between the two groups in terms of place of residence,presence of colonic polyps,neoadjuvant chemotherapy,preoperative radiotherapy,mucinous adenocarcinoma,nerve invasion,and tumour height.No significant differences were observed for other parameters.Logistic regression analysis identified colonic polyps,mucinous adenocarcinoma,nerve invasion,and tumour height as independent risk factors for sphincter preser-vation.CONCLUSION Several risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery were identified.These factors could be valuable tools for guiding clinical decision-making and optimising preoperative patient evaluations. 展开更多
关键词 Rectal cancer Laparoscopic surgery Sphincter preservation Risk factors Preoperative evaluation
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Experimental evaluation of the optimum applied pressure and number of cuffs for artificial sphincter in fluid flow control in an ex vivo model 认领 引用
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作者 Pourya Shokri Seyed Amir Mohsen Ziaee +1 位作者 Nasrin Borumandnia Shahin Tabatabaei 《Asian Journal of Urology》 CAS CSCD 2025年第3期402-406,共5页
Objective:The aim of this study was to find the optimal force that should be applied to control urine leakage using a non-hydraulic cuff design,and to investigate the relationship between the number of cuffs used in u... Objective:The aim of this study was to find the optimal force that should be applied to control urine leakage using a non-hydraulic cuff design,and to investigate the relationship between the number of cuffs used in urinary control and the change in demand force.Method:In this study,five sheep bladders were used to design and build a biomechanical evaluation system.The biomechanical system included the bladder,pressure gauge,pressure regulator system of the bladder,and force application system by the cuff.In this study,we increased the fluid pressure inside the bladder from 0 cmH2O to 200 cmH2O(1 cmH2O=0.098 kPa),and at each point,the force applied by the cuff to prevent fluid leakage was measured and recorded.Results:The study revealed that a mean tensile force of 2.81(standard deviation 0.23)N for a single cuff and 1.63(standard deviation 0.16)N for double cuffs with symmetrical pressure effectively prevented bladder fluid leakage in the pressure range from 75 cmH2O to 100 cmH2O(p<0.001).However,there were no significant differences in results when comparing the applied tensile force required by double cuffs with asymmetric tensile force to that of the single cuff use.Furthermore,using three cuffs instead of two did not yield significantly different outcomes.Conclusion:Using double cuffs with symmetrical pressure had a greater effect compared with a single cuff with the same tensile force.Although multiple cuffs with varying tensile forces were not found to be useful in controlling urine leakage in this study,it is suggested that applying variable forces alternately and rotationally among several cuffs may reduce long-term risks such as atrophy and necrosis.Future in vivo studies are recommended to further evaluate efficiency. 展开更多
关键词 Artificial urinary sphincter Calibration Urethral cuff Ex vivo study
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Problems with repairing gut sphincters malfunctions 认领 引用
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作者 Mauro Bortolotti 《World Journal of Gastrointestinal Surgery》 SCIE 2024年第8期2396-2408,共13页
Correcting a gut sphincter malfunction is a difficult problem.Because each sphincter has two opposite functions,that of closure and opening,repairing one there is a risk of damaging the other.Indeed,widening a narrow ... Correcting a gut sphincter malfunction is a difficult problem.Because each sphincter has two opposite functions,that of closure and opening,repairing one there is a risk of damaging the other.Indeed,widening a narrow sphincter,such as lower esophageal sphincter(LES)and anal sphincter,may cause gastroeso-phageal reflux and fecal incontinence,respectively,whereas narrowing a wide sphincter,may cause a difficult transit.All the corrective treatments for difficult or retrograde transit concerning LES and anal sphincter with their unwanted consequences have been analyzed and discussed.To overcome the drawbacks of sphincter surgical repairs,researchers have devised devices capable of closing and opening the gut lumen,named artificial sphincters(ASs).Their function is based on various mechanisms,e.g.,hydraulic,magnetic,mechanical etc,operating through many complicated components,such as plastic cuffs,balloons,micro-pumps,micromotors,connecting tubes and wires,electromechanical clamps,rechargeable batteries,magnetic devices,elastic bands,etc.Unfortunately,these structures may facilitate the onset of infections and induce a local fibrotic reaction,which may cause device malfunctioning,whereas the compression of the gut wall to occlude the lumen may give rise to ischemia with erosions and other lesions.Some ASs are already being used in clinical practice,despite their considerable limits,while others are still at the research stage.In view of the adverse events of the ASs mentioned above,we considered applying bioengineering methods to analyze and resolve biomechanical and biological interaction problems with the aim to conceive and build efficient and safe biomimetic ASs. 展开更多
关键词 Sphincter Artificial sphincter Magnetic sphincter Gastroesophageal sphincter Anal sphincter Gastroesophageal reflux Fecal incontinence
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Predictive model for sphincter preservation in lower rectal cancer 认领 引用 被引量：1
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作者 Yajnadatta Sarangi Ashok Kumar 《World Journal of Clinical Oncology》 2025年第8期201-219,共19页
BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisit... BACKGROUND Low rectal cancer poses a significant surgical challenge because of its close proximity to the anal sphincter,often requiring radical resection with permanent colostomy to achieve oncological safety.Revisited rectal anatomy,advances in surgical techniques and neoadjuvant therapies have enabled the possibility of sphincter-preserving procedures,however,it is uniformly not applicable.Selecting appropriate candidates for sphincter preservation is crucial,as an illadvised approach may compromise oncological outcome or lead to poor functional outcomes.Currently there is no consensus-which clinical,anatomical,or molecular factors most accurately predict the feasibility of sphincter-preserving surgery(SPS)in this subset of patients.By identifying these predictors,the study seeks to support improved patient selection,enhance surgical planning,and ultimately contribute to better functional and oncological outcomes in patients with low rectal cancer.AIM To identify predictive factors that determine the feasibility of SPS in patients with low rectal cancer.METHODS A comprehensive literature search was conducted using PubMed/MEDLINE databases.The search focused on various factors influencing the feasibility of SPS in low rectal cancer.These included patient-related factors,anatomical considerations,findings from different imaging modalities,advancements in diagnostic tools and techniques,and the role of neoadjuvant chemoradiotherapy.The relevance of each factor in predicting the potential for sphincter preservation was critically analyzed and presented based on the current evidence RESULTS Multiple studies have identified a range of predictive factors influencing the feasibility of SPS in low rectal cancer.Patient-related factors include age,sex,preoperative continence status,comorbidities,and body mass index.Anatomical considerations,such as tumor distance from the anal verge,involvement of the external anal sphincter,and levator ani muscles,also play a critical role.Additionally,a favourable response to neoadjuvant chemoradiotherapy has been associated with improved suitability for sphincter preservation.Several biomarkers,such as inflammatory markers like interleukins and C-reactive protein,as well as tumor markers like carcinoembryonic antigen,are important.Molecular markers,including BRAF and KRAS mutations and microsatellite instability status,have been linked to prognosis and may further guide decision-making regarding sphincter-preserving approaches.Artificial intelligence(AI)can further add in to select an ideal patient for sphincter preservation.CONCLUSION SPS is feasible in low rectal cancer and depends on patient factors,tumor anatomy and biology,preoperative treatment response,and biomarkers.In addition,tools and technology including AI can further help in selecting an ideal patient for long term optimal outcome. 展开更多
关键词 Low rectal cancer Surgery Sphincter preservation Predictive model Factors
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Novel technology for lower esophageal sphincter augmentation: indications and limits in current surgical practice 认领 引用 被引量：2
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作者 WANG Quan Luigi BONAVINA 《中国普通外科杂志》 CAS CSCD 北大核心 2025年第11期2310-2317,共8页
Gastroesophageal reflux disease(GERD)is primarily driven by dysfunction of the lower esophageal sphincter(LES),allowing gastric contents to reflux into the esophagus and leading to symptoms,mucosal injury,and impaired... Gastroesophageal reflux disease(GERD)is primarily driven by dysfunction of the lower esophageal sphincter(LES),allowing gastric contents to reflux into the esophagus and leading to symptoms,mucosal injury,and impaired quality of life.Traditional antireflux procedures such as Nissen,Toupet,and Dor fundoplication aim to reinforce the LES and restore the physiological and mechanical components of the antireflux barrier.Yet concerns regarding postoperative dysphagia,gas-bloat,durability,and long-term recurrence have limited their broader adoption.As advances in minimally invasive surgery have progressed,prosthetic LES augmentation devices-including the magnetic LINXTM system and the RefluxStopTM silicone implant-have emerged as reversible,anatomy preserving alternatives designed to directly enhance sphincter competence while minimizing common complications.This review summarizes the functional anatomy of the esophagogastric junction,core principles of antireflux surgery,and the mechanisms underlying fundoplication failure.Evidence from short-and long-term studies demonstrates that both Magnetic Sphincter Augmentation(MSA)and the RefluxStop procedure effectively reduce acid exposure,improve GERD-related quality of life,and provide durable reflux control,even in patients with impaired esophageal motility or prior failed surgery.These techniques complement traditional fundoplication and offer expanding therapeutic opportunities for personalized GERD management.Continued refinement of patient selection,procedural technique,and long-term evaluation will help define the optimal role of LES augmentation within contemporary antireflux surgery. 展开更多
关键词 Gastroesophageal Reflux Lower Esophageal Sphincter LES Augmentation Hiatal Hernia Fundoplication LINX Procedure RefluxStop Procedure
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The outcomes of magnetic sphincter augmentation in patients with gastroesophageal reflux disease post bariatric surgery:A systemic review and meta-analysis 认领 引用
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作者 Turki Alkully Sara Mahfoud Alghamdi +4 位作者 Najla Khalid A.Alzahrani Raghad Saeed S.Alghamdi Sarah Ibrahim Alghamdi Hassan Mahfouz H.Alghamdi Afaf Safar E.Alzahrani 《Laparoscopic, Endoscopic and Robotic Surgery》 2025年第1期45-52,共8页
Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of ... Objective:Although bariatric surgeries are widely performed around the world,patients frequently experience the recurrence of pre-existing gastroesophageal reflux disease(GERD)symptoms or develop new symptoms,some of which are resistant to medical treatment.This study investigates the effect and outcome of magnetic sphincter augmentation(MSA),a minimally invasive treatment for GERD,in this population.Methods:A thorough search of the PubMed,Cochrane,Scopus,Web of Science,and Google Scholar databases from inception until June 6,2024 was performed to retrieve relevant studies that evaluated the effects of MSA on the GERD health-related quality of life(GERD-HRQL)score and the reduction in proton pump inhibitor(PPI)use in patients who underwent bariatric surgery.The“meta”package in RStudio version 2023.12.0 t 369 was used.Results:A total of eight studies were included in the systematic review and seven studies were included in the meta-analysis.MSA significantly reduced the GERD-HRQL score(MD?27.55[95%CI:30.99 to24.11],p<0.01)and PPI use(RR?0.23[95%CI:0.16 to 0.33],p<0.01).Conclusion:MSA is a viable treatment option for patients with GERD symptoms who undergo bariatric surgery.This approach showed promising results in terms of reducing the GERD-HRQL score and reducing the use of PPI. 展开更多
关键词 Bariatric Sleeve gastrectomy Magnetic sphincter augmentation Gastroesophageal reflux
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Selective sphincteroplasty of the papilla in cases at risk due to atypical anatomy 认领 引用 被引量：6
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作者 F Mugica G Urdapilleta +6 位作者 A Castiella A Berbiela F Alzate E Zapata L Zubiaurre P Lopez JI Arenas 《World Journal of Gastroenterology》 SCIE CAS 2007年第22期3106-3111,共6页
AIM： To analyze the indications, efficacy and safety of sphincteroplasty in our centre.METHODS： A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure... AIM： To analyze the indications, efficacy and safety of sphincteroplasty in our centre.METHODS： A retrospective study of sphincteroplasty in 53 cases of papilla at high risk was performed in 2004-2006. The procedure consisted of duodenoscopy with Olympus TJF 145 Videoduodenoscope, approach to the biliary tract using a catheter with a guidewire, and dilatation of the papilla with a dilatation balloon catheter using a syringe with a manometer for control of the filling pressure.RESULTS： The indications included intradiverticular papilla in 26 patients （49%）, stenosis of a previous sphincterotomy in 19 patients （35.8%）, small size of the papilla in 4 patients （7.5%）, Billroth R gastrectomy in 3 patients （5.6%）, and coagulopathy in one patient （1.9%）. The efficacy was 97.8%, with all the calculi extracted from the common bile duct in 84.4% of the patients, even though 21 of the patients （39.6%） had calculi with a diameter equal to or greater than 10 ram. Seven patients （13.2%） presented complications： haemorrhage in 1 patient （1.9%） and mild pancreatitis in 6 patients （11.3%）. The mean hospital stay in case of complications was of 3 ± 0.63 d.CONCLUSION： Sphincteroplasty is highly effective, with a compllcation rate similar to that of sphincterotomy, furthermore, the complications are of low clinical importance. The use of the 10 mm balloon makes it possible to extract calculi with a diameter of over 15 mm and to extract more than 3 calculi without increasing the rate of complications and reduces the need to resort to lithotripsy or rescue sphincterotomy. 展开更多
关键词 Sphincteroplasty Hydrostatic dilatation of the papilla Choledocholithiasis Sphincterotomy Function of the sphincter of Oddi Acute pancreatitis Intradiverticular papilla
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Sphincter of Oddi dysfunction and pancreatitis 认领 引用 被引量：39
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作者 MT McLoughlin RMS Mitchell 《World Journal of Gastroenterology》 SCIE CAS 2007年第47期6333-6343,共11页
Sphincter of Oddi dysfunction (SOD) is a term used to describe a group of heterogenous pain syndromes caused by abnormalities in sphincter contractility. Biliary and pancreatic SOD are each sub-classified as typeⅠ,Ⅱ... Sphincter of Oddi dysfunction (SOD) is a term used to describe a group of heterogenous pain syndromes caused by abnormalities in sphincter contractility. Biliary and pancreatic SOD are each sub-classified as typeⅠ,Ⅱ or Ⅲ,according to the Milwaukee classification. SOD appears to carry an increased risk of acute pancreatitis as well as rates of post ERCP pancreatitis of over 30%. Various mechanisms have been postulated but the exact role of SOD in the pathophysiology of acute pancreatitis is unknown. There is also an association between SOD and chronic pancreatitis but it is still unclear if this is a cause or effect relationship. Management of SOD is aimed at sphincter ablation,usually by endoscopic sphincterotomy (ES). Patients with typeⅠSOD will benefit from ES in 55%-95% of cases. Sphincter of Oddi manometry is not necessary before ES in typeⅠ SOD. For patients with types Ⅱ and Ⅲ the benefit of ES is lower. These patients should be more thoroughly evaluated before performing ES. Some researchers have found that manometry and ablation of both the biliary and pancreatic sphincters is required to adequately assess and treat SOD. In pancreatic SOD up to 88% of patients will benefit from sphincterotomy. Therefore,there have been calls from some quarters for the current classification system to be scrapped in favour of an overall system encompassing both biliary and pancreatic types. Future work should be aimed at understanding the mechanisms underlying the relationship between SOD and pancreatitis and identifying patient factors that will help predict benefit from endoscopic therapy. 展开更多
关键词 Sphincter of Oddi dysfunction Pancreatitis, Post-ERCP pancreatitis, Sphincter of Oddi manometry Endoscopic sphincterotomy
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Characterization of functional biliary pain and dyspeptic symptoms in patients with sphincter of Oddi dysfunction:Effect of papillotomy 认领 引用 被引量：35
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作者 László Madácsy Roland Fejes +5 位作者 Gábor Kurucsai Ildikó Joó András Székely Viktória Bertalan Attila Szepes János Lonovics 《World Journal of Gastroenterology》 SCIE CAS 2006年第42期6850-6856,共7页
AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sph... AIM： To characterize functional biliary pain and other gastrointestinal （GI） symptoms in postcholecystectomy syndrome （PCS） patients with and without sphincter of Oddi dysfunction （SOD） proved by endoscopic sphincter of Oddi manometry （ESOM）, and to assess the postendoscopic sphincterotomy （EST） outcome. METHODS： We prospectively investigated 85 cholecystectomized patients referred for ERCP because of PCS and suspected SOD. On admission, all patients completed our questionnaire. Physical examination, laboratory tests, abdominal ultrasound, quantitative hepatobiliary scintigraphy （QHBS）, and ERCP were performed in all patients. Based on clinical and ERCP findings 15 patients had unexpected bile duct stone disease and 15 patients had SOD biliary type Ⅰ. ESOM demonstrated an elevated basal pressure in 25 patients with SOD biliary-type Ⅲ. In the remaining 30 cholecystectomized patients without SOD, the liver function tests, ERCP, QHBS and ESOM were all normal. As a control group, 30 ‘asymptomatic＇ cholecystectomized volunteers （attended to our hospital for general cardiovascular screening） completed our questionnaire, which is consisted of 50 separate questions on GI symptoms and abdominal pain characteristics. Severity of the abdominal pain （frequency and intensity） was assessed with a visual analogue scale （VAS）. In 40 of 80 patients having definite SOD （i.e. patients with SOD biliary type Ⅰ and those with elevated SO basal pressure on ESOM）, an EST was performed just afl：er ERCP. In these patients repeated questionnaires were filled at each follow-up visit （at 3 and 6 too） and a second look QHBS was performed 3 mo after the EST to assess the functional response to EST. RESULTS： The analysis of characteristics of the abdominal pain demonstrated that patients with common bile duct stone and definite SOD had a significantly higher score of symptomatic agreement with previously determined biliary-like pain features than patient groups of PCS without SOD and controls. In contrary, no significant differences were found when the pain severity scores were compared in different groups of PCS patients. In patients with definite SOD, EST induced a significant acceleration of the transpapillary bile flow; and based on the comparison of VASs obtained from the pre-and post-EST questionnaires, the severity scores of abdominal pain were significantly improved, however, only 15 of 35 （43%） patients became completely pain free. Post-EST severity of abdominal pain by VASs was significantly higher in patients with predominant dyspepsia at initial presentation as compared to those without dyspeptic symptoms. CONCLUSION： Persistent GI symptoms and general patient dissatisfaction is a rather common finding after EST in patients with SOD, and correlated with the presence of predominant dyspeptic symptoms at the initial presentation, but does not depend on the technical and functional success of EST. 展开更多
关键词 Postcholecystectomy pain Sphincter of Oddi dysfunction Functional biliary-pain Dyspeptic symptoms Endoscopic sphincterotomy Follow-up
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Medical treatment for sphincter of oddi dysfunction:Can it replace endoscopic sphincterotomy? 认领 引用 被引量：13
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作者 Véronique Vitton Salah Ezzedine +3 位作者 Jean-Michel Gonzalez Mohamed Gasmi Jean-Charles Grimaud Marc Barthet 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第14期1610-1615,共6页
AIM:To report the results of a medical management of sphincter of oddi dysfunction(SOD) after an intermediate follow-up period.METHODS:A total of 59 patients with SOD(2 men and 57 women,mean age 51 years old) were inc... AIM:To report the results of a medical management of sphincter of oddi dysfunction(SOD) after an intermediate follow-up period.METHODS:A total of 59 patients with SOD(2 men and 57 women,mean age 51 years old) were included in this prospective study.After medical treatment for one year,the patients were clinically re-evaluated after an average period of 30 mo.RESULTS:The distribution of the patients according to the Milwaukee's classification was the following:11 patients were type 1,34 were type 2 and 14 were type 3.Fourteen patients underwent an endoscopic sphincterotomy(ES) after one year of medical treatment.The median intermediate follow-up period was 29.8 ± 3 mo(3-72 mo).The initial effectiveness of the medical treatment was complete,partial and poor among 50.8%,13.5% and 35%,respectively,of the patients.At the end of the follow-up period,37 patients(62.7%) showed more than 50% improvement.The rate of improvement in patients who required ES was not significantly different compared with the patients treated conservatively(64.2% vs 62.2%,respectively).CONCLUSION:Our study confirms that conservative medical treatment could be an alternative to endoscopic sphincterotomy because,after an intermediate follow-up period,the two treatments show the same success rates. 展开更多
关键词 Sphincter of oddi dysfunction Cholecystectomy Endoscopic sphincterotomy Biliary scintigraphy
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Low rectal cancer:Sphincter preserving techniques-selection of patients,techniques and outcomes 认领 引用 被引量：17
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作者 Nikoletta Dimitriou Othon Michail +1 位作者 Dimitrios Moris John Griniatsos 《World Journal of Gastrointestinal Oncology》 SCIE 2015年第7期55-70,共16页
Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity... Low rectal cancer is traditionally treated by abdominoperineal resection. In recent years, several new techniques for the treatment of very low rectal cancer patients aiming to preserve the gastrointestinal continuity and to improve both the oncological as well as the functional outcomes, have been emerged. Literature suggest that when the intersphincteric resection is applied in T1-3 tumors located within 30-35 mm from the anal verge, is technically feasible, safe, with equal oncological outcomes compared to conventional surgery and acceptable quality of life. The Anterior Perineal Plan E for Ultra-low Anterior Resection technique, is not disrupting the sphincters, but carries a high complication rate, while the reports on the oncological and functional outcomes are limited. Transanal Endoscopic Micro Surgery(TEM) and Trans Anal Minimally Invasive Surgery(TAMIS) should represent the treatment of choice for T1 rectal tumors, with specific criteria according to the NCCN guidelines and favorable pathologic features. Alternatively to the standard conventional surgery, neoadjuvant chemo-radiotherapy followed by TEM or TAMIS seems promising for tumors of a local stage T1sm2-3 or T2. Transanal Total Mesorectal Excision should be performed only when a board approved protocol is available by colorectal surgeons with extensive experience in minimally invasive and transanal endoscopic surgery. 展开更多
关键词 Low rectal cancer Sphincter preservingsurgery Intersphincteric resection Anterior PerinealPlanE for Ultra-low Anterior Resection of the Rectum Total mesorectal excision TransAnal Minimally InvasiveSurgery Transanal Total Mesorectal Excision Quality oflife Oncological outcome Functional outcome
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Evaluating the efficacy of endoscopic sphincterotomy on biliary-type sphincter of Oddi dysfunction: A retrospective clinical trial 认领 引用 被引量：8
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作者 Li-Kun Ren Zhi-Yuan Cai +6 位作者 Xun Ran Neng-Hong Yang Xing-Zhi Li Hao Liu Chang-Wei Wu Wen-Ying Zeng Min Han 《World Journal of Clinical Cases》 SCIE 2021年第32期9835-9846,共12页
BACKGROUND Although endoscopic sphincterotomy(EST)has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction(SOD),some patients still have little relief after EST,which implies that other function... BACKGROUND Although endoscopic sphincterotomy(EST)has a positive therapeutic effect on biliary-type sphincter of Oddi dysfunction(SOD),some patients still have little relief after EST,which implies that other functional abdominal pain may also be present with biliary-type SOD and interfere with the diagnosis and treatment of it.AIM To retrospectively assess EST as a treatment for biliary-type SOD and analyze the importance of functional gastrointestinal disorder(FGID)in guiding endoscopic treatment of SOD.METHODS Clinical data of 79 patients with biliary-type SOD(type I and type II)treated with EST at Affiliated Hospital of Guizhou Medical University from January 2014 to January 2019 were retrospectively collected to evaluate the clinical therapeutic effect of EST.The significance of relationship between FGID and biliary-type SOD was analyzed.RESULTS Seventy-nine patients with biliary-type SOD received EST,including 29 type 1 patients and 50 type 2 patients.The verbal rating scale-5(VRS-5)scores before EST were all 3 or 4 points,and the scores decreased after EST;the difference was statistically significant(P0.05).Of 12 biliary-type SOD(with FGID)patients,11 had abdominal pain after EST;of 67 biliary-type SOD(without FGID)patients,0 had abdominal pain after EST.The difference was statistically significant(P<0.05).The 11 biliary-type SOD(with FGID)patients with recurrence of symptoms,the recurrence time was about half a year after the EST,and the symptoms were significantly relieved after regular medical treatment.There were 4 cases of postendoscopic retrograde cholangiopancreatography pancreatitis(5.1%),and no cholangitis,bleeding or perforation occurred.Patients were followed up for 1 year to 5 years after EST,with an average follow-up time of 2.34 years,and there were no long-term adverse events such as sphincter of Oddi restenosis or cholangitis caused by intestinal bile reflux during the follow-up.CONCLUSION EST is a safe and effective treatment for SOD.For patients with type I and II SOD combined with FGID,single EST or medical treatment has limited efficacy.It is recommended that EST and medicine be combined to improve the cure rate of such patients. 展开更多
关键词 Sphincter of Oddi dysfunction Endoscopic sphincterotomy Functional gastrointestinal disorders Functional dyspepsia Functional heartburn Irritable bowel syndrome Curative effect
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Severe acute cholangitis after endoscopic sphincterotomy induced by barium examination:A case report 认领 引用 被引量：2
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作者 Zhen-Hai Zhang Ya-Guang Wu +4 位作者 Cheng-Kun Qin Zhong-Xue Su Jian Xu Guo-Zhe Xian Shuo-Dong Wu 《World Journal of Gastroenterology》 SCIE CAS CSCD 2012年第39期5658-5660,共3页
Endoscopic sphincterotomy (EST) is considered as a possible etiological factor for severe cholangitis. We herein report a case of severe cholangitis after endo-scopic sphincterotomy induced by barium examination. An a... Endoscopic sphincterotomy (EST) is considered as a possible etiological factor for severe cholangitis. We herein report a case of severe cholangitis after endo-scopic sphincterotomy induced by barium examination. An adult male patient presented with epigastric pain was diagnosed as having choledocholithiasis by ultra-sonography. EST was performed and the stone was completely cleaned. Barium examination was done 3 d after EST and severe cholangitis appeared 4 h later. The patient was recovered after treated with tienam for 4 d. Barium examination may induce severe cholangitis in patients after EST, although rare, barium examination should be chosen cautiously. Cautions should be also used when EST is performed in patients younger than 50 years to avoid the damage to the sphincter of Oddi. 展开更多
关键词 Endoscopic sphincterotomy Severe cholan-gitis Barium examination Sphincter of Oddi
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Factors influencing lower esophageal sphincter relaxation after deglutition 认领 引用 被引量：1
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作者 Lita Tibbling Per Gezelius Thomas Franzén 《World Journal of Gastroenterology》 SCIE CAS CSCD 2011年第23期2844-2847,共4页
AIM:To study the relationship between upper esophageal sphincter (UES) relaxation,peristaltic pressure and lower esophageal sphincter (LES) relaxation following deglutition in non-dysphagic subjects.METHODS:Ten non-dy... AIM:To study the relationship between upper esophageal sphincter (UES) relaxation,peristaltic pressure and lower esophageal sphincter (LES) relaxation following deglutition in non-dysphagic subjects.METHODS:Ten non-dysphagic adult subjects had a high-resolution manometry probe passed transnasally and positioned to cover the UES,the esophageal body and the LES.Ten water swallows in each subject were analyzed for time lag between UES relaxation and LES relaxation,LES pressure at time of UES relaxation,duration of LES relaxation,the distance between the transition level (TL) and the LES,time in seconds that the peristaltic wave was before (negative value) or after the TL when the LES became relaxed,and the maximal peristaltic pressure in the body of the esophagus.RESULTS:Relaxation of the LES occurred on average 3.5 s after the bolus had passed the UES and in most cases when the peristaltic wave front had reached the TL.The LES remained relaxed until the peristaltic wave faded away above the LES.CONCLUSION:LES relaxation seemed to be caused by the peristaltic wave pushing the bolus from behind against the LES gate. 展开更多
关键词 Deglutition Lower esophageal sphincter Peristalsis Relaxation Upper esophageal sphincter
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