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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 | Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement显示文摘 | Gregorios Paspatis Jean-Marc Dumonceau Marc Barthet S?ren Meisner Alessandro Repici Brian Saunders Antonios Vezakis Jean Gonzalez Stine Turino Zacharias Tsiamoulos Paul Fockens Cesare Hassan | 2014 | Endoscopy2014，，： | 4 |
| 4 | 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 |
| 5 | A new tension-free technique for the repair of umbilical hernia,using the Prolene Hernia System-early results from 48 cases显示文摘 | Perrakis E Velimezis G Vezakis A | 2003 | Hernia2003，7，4： | 1 |
| 6 | Laparoscopic surgery combined with preservaion of the spleen for distal pancreatic tumors显示文摘 | VEZAKIS A DAVIDES D LARVIN M | 1999 | Surg-Endosc1999，13，1： | 1 |
| 7 | A new tension - free technique for the repair of umbilical hernia, using the Prolene Hernia System - - early results from 48 cases 显示文摘 | Perrakis E Velimezis G Vezakis A | 2003 | Hernia2003，7，4： | 1 |
| 8 | Laparosopic cholecystectomy : are patients with biliary pancreatitas at increased operative risk? 显示文摘 | Ammor BJ Davides D Vezakis A | 2003 | Surg Endosc2003，17，5： | 1 |
| 9 | Randomized comparison between low-pressure laparoscopic cholecystectomy and gasless laparoscopic cholecystectomy显示文摘 | Vezakis A Davides D Gibson JS | 1999 | Surg Endosc1999，13，9： | 1 |
| 10 | A new tension-free technique for the repair of umbilical hernia,using the Prolene Hernia System-early results from 48 cases显示文摘 | Perrakis E Velimezis G Vezakis A | 2003 | Hernia2003，7，4： | 1 |
| 11 | A new tension-free technique for the repair of umbilical hernia, using the Prolene Hernia System — early results from 48 cases显示文摘 | E. Perrakis G. Velimezis A. Vezakis J. Antoniades G. Savanis V. Patrikakos | 2003 | Hernia2003，，4： | 1 |
| 12 | Laparoscopic treatment of Mirizzi syndrome显示文摘 | Vezakis A Davides D Birbas K | 2000 | Surg Laparosc Endosc Percutan Tech2000，10，1： | 1 |
| 13 | Intraoperative cholangiography during laparoscopic cholecystectomy 显示文摘 | Vezakis A Davides D Ammori BJ | 2000 | Surg Endosc2000，14，12： | 1 |
| 14 | Seronegative cat-scratch disease diagnosed by PCR detection of Bartonella hens-elae DNA in lymph node samples显示文摘 | Chondrogiannis K Vezakis A Derpapas M | 2012 | Braz J Infect Dis2012，16，1： | 1 |
| 15 | Laparoscopic cholecystectomy:are patients with biliary panereatitis at increased operative fisk显示文摘 | Ammori BJ Davides D Vezakis A | 2003 | Surg Endose2003，17，5： | 1 |
| 16 | Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate显示文摘 | Panteris V Vezakis A Filippou G | | 0，，5： | 1 |
| 17 | Influence of juxtapapillary diverticula on the success or difficulty of cannulation and complication rate显示文摘 | Panteris V Vezakis A Filippou G | | 0，，5： | 1 |
| 18 | Laparoscopic cholecystectomy:are patients with biliary pancreatitis at increased operative risk?显示文摘 | Ammori BJ Davides D Vezakis A | 2003 | Surg Endosc2003，17，5： | 1 |
| 19 | Intraoperative cholangiography during laparoscopic cholecystectomy显示文摘 | Vezakis A Davides D Ammori BJ | 2000 | Surg Endosc2000，14，12： | 1 |
| 20 | Leparoscopic surgery combined with preservation of the spleen for distal pancreatic tumor显示文摘 | Davide S D | 1999 | Surg Endosc1999，13，： | 1 |
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