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| 1 | Endoscopic retrograde cholangiopancreatography-related perforations: Diagnosis and management显示文摘Endoscopic retrograde cholangiopancreatography(ERCP) has become an important therapeutic modality for biliary and pancreatic disorders. Perforation is one of the most feared complications of ERCP and endoscopic sphincterotomy. A MEDLINE search was performedfrom 2000-2014 using the keywords 'perforation', 'ERCP' and 'endoscopic sphincterotomy'. All articles including more than nine cases were reviewed. The incidence of ERCP-related perforations was low(0.39%, 95%CI: 0.34-0.69) with an associated mortality of 7.8%(95%CI: 3.80-13.07). Endoscopic sphincterotomy was responsible for 41% of perforations, insertion and manipulations of the endoscope for 26%, guidewires for 15%, dilation of strictures for 3%, other instruments for 4%, stent insertion or migration for 2% and in 7% of cases the etiology was unknown. The diagnosis was made during ERCP in 73% of cases. The mechanism, site and extent of injury, suggested by clinical and radiographic findings, should guide towards operative or non-operative management. In type I perforations early surgical repair is indicated, unless endoscopic closure can be achieved. Patients with type II perforations should be treated initially non-operatively. Non-operative treatment includes biliary stenting, fasting, intravenous fluid resuscitation, nasogastric drainage, broad spectrum antibiotics, percutaneous drainage of fluid collections. Non-operative treatment was successful in 79% of patients with type II injuries, with an overall mortality of 9.4%. Non-operative treatment was sufficient in all patients with type III injuries. Surgical technique depends on timing, site and size of defect and clinical condition of the patient. In conclusion, diagnosis is based on clinical suspicion and clinical and radiographic findings. Whilst surgery is usually indicated in patients with type I injuries, patients with type II or III injuries should be treated initially non-operatively. A minority of them will finally require surgical intervention. | Antonios Vezakis Georgios Fragulidis Andreas Polydorou | 2015 | World Journal of Gastrointestinal Endoscopy2015，7，14： | 17 |
| 2 | Closure of a persistent sphincterotomy-related duodenal perforation by placement of a covered self-expandable metallic biliary stent显示文摘Retroperitoneal duodenal perforation as a result of endoscopic biliary sphincterotomy is a rare complication, but it is associated with a relatively high mortality risk, if left untreated. Recently, several endoscopic techniques have been described to close a variety of perforations. In this case report, we describe the closure of a persistent sphincterotomy-related duodenal perforation by using a covered self-expandable metallic biliary (CEMB) stent. A 61-year-old Greek woman underwent an endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy for suspected choledo-cholithiasis, and a retroperitoneal duodenal perforation (sphincterotomy-related) occurred. Despite initial conservative management, the patient underwent a laparotomy and drainage of the retroperitoneal space. After that, a high volume duodenal fistula developed. Six weeks after the initial ERCP, the patient underwent a repeat endoscopy and placement of a CEMB stent with an indwelling nasobiliary drain. The fistula healed completely and the stent was removed two weeks later. We suggest the transient use of CEMB stents for the closure of sphincterotomy-related duodenal perforations. They can be placed either during the initial ERCP or even later if there is radiographic or clinical evidence that the leakage persists. | Antonios Vezakis Georgios Fragulidis Constantinos Nastos Anneza Yallourou Andreas Polydorou Dionisios Voros | 2011 | World Journal of Gastroenterology2011，17，40： | 11 |
| 3 | Surgical approaches of resectable synchronous colorectal liver metastases:Timing considerations显示文摘AIM: To compare the safety and efficacy of simultaneous versus two stage resection of primary colorectal tumors and liver metastases. METHODS: From January 1996 to May 2004, 103 colorectal tumor patients presented with synchronous liver metastases. Twenty five underwent simultaneous colorectal and liver surgery and 78 underwent liver surgery 1-3 mo after primary colorectal tumor resection. Data were retrospectively analyzed to assess and compare the morbidity and mortality between the surgical strategies. The two groups were comparable regarding the age and sex distribution, the types of liver resection and stage of primary tumors, as well as the number and size of liver metastases. RESULTS: In two-stage procedures more transfusions were required (4 ± 1.5 vs 2 ± 1.8, pRBCs, P < 0.05). Chest infection was increased after the two-stage approach (26% vs 17%, P < 0.05). The two-stage procedure was also associated with longer hospitalization (20 ± 8 vs 12 ± 6 d, P < 0.05). Five year survival in both groups was similar (28% vs 31%). No hospital mortality occurred in our series. CONCLUSION: Synchronous colorectal liver metastases can be safely treated simultaneously with the primary tumor. Liver resection should be prioritized over colon resection. It is advisable that complex liver resections with marginal liver residual volume should be dealt with at a later stage. | Ioannis Vassiliou Nick Arkadopoulos Theodosios Theodosopoulos Georgios Fragulidis Athanasios Marinis Agathi Kondi-Paphiti Lazaros Samanides Andreas Polydorou Constantinos Gennatas Dionysios Voros Vassilios Smyrniotis | 2007 | World Journal of Gastroenterology2007，13，9： | 8 |
| 4 | Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery:An algorithmic approach显示文摘AIM:To investigate injuries of anatomy variants of hepatic duct confluence during hepatobiliary surgery and their impact on morbidity and mortality of these procedures. An algorithmic approach for the management of these injuries is proposed. METHODS:During a 6-year period 234 patients who had undergone major hepatobiliary surgery were retrospectively reviewed in order to study postoperative bile leakage. Diagnostic workup included endoscopic and magnetic retrograde cholangiopancreatography (E/MRCP), scintigraphy and fistulography. RESULTS:Thirty (12.8%) patients who developed postoperative bile leaks were identified. Endoscopic stenting and percutaneous drainage were successful in 23 patients with bile leaks from the liver cut surface. In the rest seven patients with injuries of hepatic duct confluence, biliary variations were recognized and a stepwise therapeutic approach was considered. Conservative management was successful only in 2 patients. Volume of the liver remnant and functional liver reserve as well as local sepsis were used as criteria for either resection of the corresponding liver segment or construction of a biliary-enteric anastomosis. Two deaths occurred in this group of patients with hepatic duct confluence variants (mortality rate 28.5%). CONCLUSION:Management of major biliary fistulaethat are disconnected from the mainstream of the biliary tree and related to injury of variants of the hepatic duct confluence is extremely challenging. These patients have a grave prognosis and an early surgical procedure has to be considered. | Georgios Fragulidis Athanasios Marinis Andreas Polydorou Christos Konstantinidis Georgios Anastasopoulos John Contis Dionysios Voros Vassilios Smyrniotis | 2008 | World Journal of Gastroenterology2008，14，19： | 3 |
| 5 | Effects of endoscopic sphincterotomy on biliary epithelium:A case-control study显示文摘AIM: To study the long-term effects of endoscopic sphincterotomy on biliary epithelium. METHODS: This is a prospective case-control study. A total of 25 patients with a median age of 71 years (range 49-89 years) and prior endoscopic sphincterotomy (ES) for benign disease formed the fi rst group. The median time from ES was 42 mo (range 8-144 mo). Another 25 patients with a median age of 76 years (range 44-94 mo) and similar characteristics who underwent current endoscopic retrograde cholangio-pancreatography (ERCP) and ES for benign disease formed the second group (control group). Brush cytology of the biliary tree with p53 immunocytology was performed in all patients of both groups. ERCPs and recruitment were conducted at the Endoscopic Unit of Aretaieion University Hospital and Tzaneio Hospital, Athens, from October 2006 to June 2010. RESULTS: No cases were positive or suspicious for malignancy. Epithelial atypia was higher in the first group (32% vs 8% in the second group, P = 0.034). Acute cholangitis and previous biliary operation rates were also higher in the fi rst group (acute cholangitis, 60% vs 24% in the second group, P = 0.01; previous biliary operation, 76% vs 24% in the second group, P = 0.001). Subgroup analysis showed that previous ES was the main causal factor for atypia, which was not related to the time interval from the ES (P = 0.407). Two patients (8%) with atypia in the fi rst group were p53-positive. CONCLUSION: ES causes biliary epithelial atypia that represents mostly reactive/proliferative rather than premalignant changes. The role of p53 immunoreactivity in biliary atypia needs to be further studied. | John Kalaitzis Antonios Vezakis George Fragulidis Irene Anagnostopoulou Spyros Rizos Efstathios Papalambros Andreas Polydorou | 2012 | World Journal of Gastroenterology2012，18，8： | 3 |
| 6 | Comparison of taerolimus with microemulsion cyelosporine as primary immunosuppression in hepatitis C patients after liver transplantation显示文摘 | Zervos X A Weppler D Fragulidis G P Torres M B Nery J R Khan M F | 1998 | Transplantation1998，65，： | 1 |
| 7 | Comparison of tacrolimus with neoral as pri mary immunosuppression in hepatitis C patients after liver transplantation显示文摘 | Zervos X A Weppler D Fragulidis G P Torres M B Nery J R Khan M F | 1998 | Transplant Proc1998，30，： | 1 |
| 8 | Management of a ruptured bile duct cyst显示文摘 | Georgios P. Fragulidis Athanasios D. Marinis Georgios V. Anastasopoulos Georgios K. Vasilikostas Vasilis Koutoulidis | 2007 | Journal of Hepato - Biliary - Pancreatic Surgery2007，，2： | 1 |
| 9 | Isolated jejunal perforation following blunt abdominal trauma显示文摘 | Kostantinidis C Pitsinis V Fragulidis G | 2010 | Ulus Travma Acil Cerrahi Derg2010，16，1： | 1 |
| 10 | Correla- tion of the ICG test with risk factors and postoperative outcomes following hepatic resection 显示文摘 | Derpapas MK Contis J Fragulidis GP | 2013 | J BUON2013，18，3： | 1 |
| 11 | Comparison of tacrolimus with microemulsion cyclosporine as primary immunosuppression in hepa- titis C patients after liver transplantation 显示文摘 | Zervos XA Weppler D Fragulidis GP | 1998 | Transplantation1998，65，8： | 1 |
| 12 | Seronegative cat-scratch disease diagnosed by PCR detection of Bartonella henselae DNA in lymph node samples显示文摘 | Konstantinos Chondrogiannis Antonios Vezakis Michael Derpapas Aikaterini Melemeni Georgios Fragulidis | 2012 | Brazilian Journal of Infectious Diseases2012，，： | 1 |
| 13 | A Multimodal Approach to Acute Biliary Pancreatitis During Pregnancy: A Case Series显示文摘 | Andreas Polydorou Konstantinos Karapanos Antonios Vezakis Aikaterini Melemeni Vasilios Koutoulidis Georgios Polymeneas Georgios Fragulidis | 2012 | Surgical Laparoscopy Endoscopy & Percutaneous Techniques2012，，5： | 1 |
| 14 | Correlation of the ICG test with risk factors and postoperative outcomes following hepatic resection显示文摘 | Derpapas MK Contis J Fragulidis GP | | 0，，03： | 1 |
| 15 | Isolated jejunal perfo- ration following blunt abdominal trauma 显示文摘 | Kostantinidis C Pitsinis V Fragulidis G | 2010 | Ulus Travma Acil Cerrahi Derg2010，16，1： | 1 |
| 16 | An ongoing dispute in the management of severe pancreatic fistula:Pancreatospleenectomy or not?显示文摘The aim of this manuscript is to review controversies in managing severe pancreatic fistula after pancreatic surgery.Significant progress in surgical technique and perioperative care has reduced the mortality rate of pancreatic surgery.However,leakage of the pancreatic stump still accounts for the majority of surgical complications after pancreatic resection.Various strategies have been employed in order to manage pancreatic fistula.Nonetheless high grade pancreatic fistula evokes controversy in relation to the choice of treatment.A Medline search was performed,with regard to conservative treatment options versus completion pancreatectomy for the management of pancreatic fistula grade C.Pancreatic fistula rates remain unchanged with an incidence ranging from 5%-20% and this is considered as the most important cause of postoperative death.Many authors claim that completion pancreatectomy has probably lost its role in favour of interventional radiology procedures,while others believe that completion pancreatectomy continues to have a place in the management of patients with severe clinical deterioration after pancreatic fistula who do not respond to non-surgical interventions.There is no agreement on the best clinical management of severe pancreatic fistula after pancreatic surgery.Completion pancreatectomy is reserved for patients not improving with conventional measures. | Dionysios Dellaportas Aliki Tympa Constantinos Nastos Vasiliki Psychogiou Andreas Karakatsanis Andreas Polydorou George Fragulidis Ioannis Vassiliou Vassilios Smyrniotis | 2010 | World Journal of Gastrointestinal Surgery2010，2，11： | 0 |
| 17 | Subcutaneous extension of a large diaphragmatic hydatid cyst显示文摘A 53-year-old male patient with a large hydatid cyst of the left hemidiaphragm and smaller secondary cysts located in the left thoracic cavity and upper left abdominal quadrant presented with two progressively enlarging lipoma-like masses in the left hypochondrium and under the left scapulae respectively. Total excision of all the cysts was performed through a bilateral subcostal incision, with the left hemidiaphragm near totally excised and replaced by a synthetic bilayer mesh. | Athanasios Marinis Georgios Fragulidis Konstantinos Karapanos Christos Konstantinidis Paraskevas Brestas John Vassiliou Vassilios Smyrniotis | 2006 | World Journal of Gastroenterology2006，12，44： | 0 |
| 18 | Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases显示文摘AIM:To test whether clamping during liver surgery predisposes to hepatic vein thrombosis.METHODS:We performed a retrospective analysis of 210 patients who underwent liver resection with simultaneous inflow and outflow occlusion.Intraoperatively,flow in the hepatic veins was assessed by Doppler ultrasonography during the reperfusion phase.Postoperatively,patency of the hepatic veins was assessed by contrast-enhanced CT angiography,when necessary after 3-6 mo follow up.RESULTS:Twelve patients(5.7%) developed intraoperative liver remnant swelling.However,intraoperative ultrasonography did not reveal evidence of hepatic vein thrombosis.In three of these patients a kinking of the common trunk of the middle and left hepatic veins hindering outflow was recognized and was managed successfully bysuturing the liver remnant to the diaphragm.Twenty three patients(10.9%) who developed signs of mild outflow obstruction postoperatively,had no evidence of thrombi in the hepatic veins or flow disturbances on ultrasonography and contrast-enhanced CT angiography,while hospitalized.Long term assessment of the patency of the hepatic veins over a 3-6 mo follow-up period did not reveal thrombi formation or clinical manifestations of out flow obstruction.CONCLUSION:Extrahepatic dissection and clamping of the hepatic veins does not predispose to clinically important thrombosis. | Nikolaos Arkadopoulos Vaia Stafyla Athanasios Marinis Vassilios Koutoulidis Kassiani Theodoraki Theodosios Theodosopoulos Ioannis Vassiliou Nikolaos Dafnios Georgios Fragulidis Vassilios Smyrniotis | 2009 | World Journal of Gastroenterology2009，15，3： | 0 |
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