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| 1 | Endoscopic ultrasound in the diagnosis and treatment of pancreatic disease显示文摘Endoscopic ultrasound(EUS)is an important part of modern gastrointestinal endoscopy and now has an integral role in the diagnostic evaluation of pancreatic diseases.Furthermore,as EUS technology has advanced,it has increasingly become a therapeutic procedure,and the prospect of multiple applications of interventional EUS for the pancreas is truly on the near horizon.However,this review focuses on the established diagnostic and therapeutic roles of EUS that are used in current clinical practice.In particular,the diagnostic evaluation of acute pancreatitis,chronic pancreatitis,cystic pancreatic lesions and solid masses of the pancreas are discussed.The newer enhanced imaging modalities of elastography and contrast enhancement are evaluated in this context.The main therapeutic aspects of pancreatic EUS are then considered,namely celiac plexus block and celiac plexus neurolysis for pain control in chronic pancreatitis and pancreas cancer,and EUS-guided drainage of pancreatic fluid collections. | Christopher W Teshima Gurpal S Sandha | 2014 | World Journal of Gastroenterology2014，20，29： | 9 |
| 2 | Small bowel endoscopy for obscure GI bleeding显示文摘 | Christopher W. Teshima | 2012 | Best Practice & Research Clinical Gastroenterology2012，，3： | 2 |
| 3 | Clinical characteristics of young patients with early Barrett’s neoplasia显示文摘BACKGROUND Esophageal adenocarcinoma(EAC)and high-grade dysplasia(HGD)may appear in young patients with Barrett's esophagus(BE).However,characteristics of Barrett's-related neoplasia in this younger population remain unknown.AIM To identify clinical characteristics that differ between young and old patients with early-stage Barrett's-related neoplasia.METHODS We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients with early-stage EAC(pT1)and HGD at a tertiary-referral center between 2001 and 2017.Baseline characteristics,drug and risk factor exposures,clinicopathological staging of EAC/HGD and treatment outcomes[complete eradication of neoplasia(CE-N),complete eradication of intestinal metaplasia(CE-IM),recurrence of neoplasia and recurrence of intestinal metaplasia]were retrieved.Multivariate analyses were performed to identify factors that differed significantly between older and younger(≤50 years)patients.RESULTS We identified 450 patients with T1 EAC and HGD(74%and 26%,respectively);45(10%)were≤50 years.Compared to the older group,young patients were more likely to present with ongoing gastroesophageal reflux disease(GERD)symptoms(55%vs 38%,P=0.04)and to be obese(body mass index>30,48%vs 32%,P=0.04).Multivariate logistic regression analysis showed that young patients were significantly more likely to have ongoing GERD symptoms[odds ratio(OR)2.00,95%confidence interval(CI)1.04-3.85,P=0.04]and to be obese(OR 2.06,95%CI 1.07-3.98,P=0.03)whereas the young group was less likely to have a smoking history(OR 0.39,95%CI 0.20-0.75,P<0.01)compared to the old group.However,there were no significant differences regarding tumor histology,CE-N,CE-IM,recurrence of neoplasia and recurrence of intestinal metaplasia(mean follow-up,44.3 mo).CONCLUSION While guidelines recommend BE screening in patients>50 years of age,younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms. | Yugo Iwaya Yuto Shimamura Kenichi Goda Enrique Rodríguez de Santiago John Gerard Coneys Jeffrey D Mosko Gabor Kandel Paul Kortan Gary May Norman Marcon Christopher Teshima | 2019 | World Journal of Gastroenterology2019，25，24： | 1 |
| 4 | Magnetic imaging-assisted colonoscopy vs conventional colonoscopy: A randomized controlled trial显示文摘AIM: To compare magnetic imaging-assisted colonoscopy(MIC) with conventional colonoscopy(CC).METHODS: Magnetic imaging technology provides a computer-generated image of the shape and position of the colonoscope onto a monitor to give visual guidance to the endoscopist. It is designed to improve colonoscopy performance and tolerability for patients by enabling visualization of loop formation and endoscope position. Recently, a new version of MIC technology was developed for which there are limited data.To evaluate this latest generation of MIC among experienced rather than inexperienced or trainee endoscopists, a prospective randomized trial was performed using only gastroenterologists with therapeutic endoscopy training. Consecutive patients undergoing elective outpatient colonoscopy were randomized to MIC or CC, with patients blinded to their group assignment. Endoscopic procedural metrics and quantities of conscious sedation medications were recorded during the procedures. The procedure was classified as 'usual' or 'difficult' by the endoscopist at the conclusion of each case based on the need for adjunctive maneuvers to facilitate endoscope advancement. After more than one hour post-procedure, patients completed a 10 cm visual analogue pain scale to reflect the degree of discomfort experienced during their colonoscopy. The primary outcome was patient comfort expressed by the visual analogue pain score. Secondary outcomes consisted of endoscopic procedural metrics as well as a sedation score derived from standardized dose increments of the conscious sedation medications.RESULTS: Two hundred fifty-three patients were randomized and underwent MIC or CC between September 2011 and October 2012. The groups were similar in terms of the indications for colonoscopy and patient characteristics. There were no differences in cecal intubation rates(100% vs 99%), insertion distance-tocecum(82 cm vs 83 cm), time-to-cecum(6.5 min vs 7.2 min), or polyp detection rate(47% vs 52%) between the MIC and CC groups. The primary outcome of mean pain score(1.0 vs 0.9 out of 10, P = 0.41) did not differ between MIC and CC groups, nor did the mean sedation score(8.2 vs 8.5, P = 0.34). Within the subgroup of cases considered more challenging or difficult, timeto-cecum was significantly faster with MIC compared to CC, 10.1 min vs 13.4 min respectively(P = 0.01). Sensitivity analyses confirmed a similar pattern of overall findings when each endoscopist was considered separately, demonstrating that the mean results for the entire group were not unduly influenced by outlier results from any one endoscopist.CONCLUSION: Although the latest version of MIC resulted in faster times-to-cecum within a subgroup of more challenging cases, overall it was no better than CC in terms of patient comfort, sedation requirements and endoscopic procedural metrics, when performed in experienced hands. | Christopher W Teshima Sergio Zepeda-Gómez Suliman H AlShankiti Gurpal S Sandha | 2014 | World Journal of Gastroenterology2014，20，36： | 1 |
| 5 | Abnormal intestinal permeability in Crohn’s disease pathogenesis显示文摘 | Christopher W. Teshima Levinus A. Dieleman Jon B. Meddings | 2012 | Annals of the New York Academy of Sciences2012，，1： | 1 |
| 6 | Crohn's disease genotypes of patients in remission vs relapses after infliximab discontinuation显示文摘AIM:To investigate genetic differences between Crohn's disease(CD) patients with a sustained remission vs relapsers after discontinuing infliximab while in corticosteroid-free remission.METHODS:Forty-eight CD patients received infliximab and were in full corticosteroid-free clinical remission but then discontinued infliximab for reasons other than a loss of response,were identified by review of an electronic database and charts.Infliximab-associated remission was defined as corticosteroid-free plus normalization of clinical disease activity [CD activity index(CDAI) < 150] during follow-up visits based on physician global assessments.A CD relapse(loss of infliximab-induced remission) was clinically defined as a physician visit for symptoms of disease activity(CDAI > 220) and a therapeutic intervention with CD medication(s),or a hospitalization with complications related to active CD.Genetic analyses were performed on samples from 14 patients(n = 6 who had a sustained long term remission after stopping infliximab,n = 8 who rapidly relapsed after stopping infliximab).Nucleotide-binding oligomerization domain 2(NOD2)/caspase activation recruitment domain 15(CARD15) polymorphisms(R702W,G908R and L1007fs) and the inflammatory bowel disease 5(IBD5) polymorphisms(IGR2060a1 and IGR3081a1) were analyzed in each group.RESULTS:Five single nucleotide polymorphisms of IBD5 and NOD2/CARD15 genes were successfully analyzed for all 14 subjects.There was no significant increase in frequency of the NOD2/CARD15 polymorphisms(R702W,G908R and L1007fs) and the IBD5 polymorphisms(IGR2060a1 and IGR3081a1) in either group of patients;those whose disease relapsed rapidly or those who remained in sustained long term remission following the discontinuation of infliximab.Nearly a third of patients in full clinical remission who stopped infliximab for reasons other than loss of response remained in sustained clinical remission,while two-thirds relapsed rapidly.There was a marked difference in the duration of clinical remission following discontinuance of infliximab between the two groups.The patients who lost remission did so after 1.0 years ± 0.6 years,while those still in remission were at the time of this study,8.1 years ± 2.6 years post-discontinuation of infliximab,P < 0.001.The 8 patients who had lost remission after discontinuing infliximab had a mean number of 5 infusions(range 3-7),with a mean treatment time of 7.2 mo(range 1.5 mo-15 mo).The mean duration of time from the last infusion of infliximab to the time of loss of remission was 382 d(range 20 d-701 d).The 6 patients who remained in remission after discontinuing infliximab had a mean number of 6 infusions(range 3-12),with a mean treatment duration of 12 mo(range 3.6 mo-32 mo)(P = 0.45 relative to those who lost remission).CONCLUSION:There are no IBD5 or NOD2/CARD15 mutations that predict which patients might have sustained remission and which will relapse rapidly after stopping infliximab. | Cathy Lu Alistair Waugh Robert J Bailey Raeleen Cherry Levinus A Dieleman Leah Gramlich Kata Matic Mario Millan Karen I Kroeker Daniel Sadowski Christopher W Teshima Dennis Todoruk Clarence Wong Karen Wong Richard N Fedorak | 2012 | World Journal of Gastroenterology2012，18，36： | 1 |
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