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Topic Review
Direct Endoscopic Necrosectomy
Walled-off pancreatic necrosis (WOPN) is one of the local complications of acute pancreatitis (AP). Several interventional techniques have been developed over the last few years. The purpose of this entry is to explore such methodologies, with specific focus on endoscopic drainage and direct endoscopic necrosectomy (DEN), through evaluation of their indications and timing for intervention. Findings indicated how, after the introduction of lumen-apposing metal stents (LAMS), DEN is becoming the favorite technique to treat WOPN, especially when large solid debris or infection are present. Additionally, DEN is associated with a lower adverse events rate and hospital stay, and with improved clinical outcome.
  • 380
  • 19 Apr 2022
Topic Review
Risk Factors for Pancreatic Cancer
Pancreatic cancer is one of the most aggressive malignant neoplastic diseases. The incidence and mortality rates of this disease vary depending on geographical area, which might be explained by the different exposure to risk factors. Currently, the risk factors for pancreatic cancer fall into two broad categories, namely extrinsic and intrinsic factors. Extrinsic factors include alcohol consumption, smoking, a diet rich in saturated fats, and viral infections such as chronic infection with hepatitis B and C viruses. The pathophysiological mechanisms explaining how these hepatotropic viruses contribute to the development of pancreatic cancer are not fully elucidated. The common origin of hepatocytes and pancreatic cells in the multipotent endodermal cells, the common origin of the blood vessels and biliary ducts of the pancreas and the liver, or chronic inflammatory changes may be involved in this interaction.
  • 491
  • 19 Apr 2022
Topic Review
Role of HIF-1 and NRF2 in Pancreatic Cancer
Hypoxia inducible factor-1 and KEAP1-NRF2, stress response mechanisms for hypoxia and oxidative stress, respectively, contribute to the aggressive behaviors of pancreatic cancer. These key molecules for stress response mechanisms are activated, both in pancreatic cancer cells and in pancreatic stellate cells. Both factors are involved in the mutual activation of cancer cells and stellate cells, by inducing cancer-promoting signals and their mediators. Therapeutic interventions targeting these pathways are promising approaches for novel therapies.
  • 309
  • 19 Apr 2022
Topic Review
Systemic Therapies for Hepatocellular Carcinoma
Clinical treatment of Hepatocellular carcinoma (HCC) in initial stages includes surgical therapies, resection or tumor ablation, transplantation and transarterial chemoembolization (TACE). In advanced HCC, useful systemic therapies were not available for patients until 2007, when sorafenib was approved.After years without major therapeutic improvements and with increasing incidence, finally advances are arriving for HCC treatment. Sorafenib is no longer the only systemic therapy for patients, and novel combinations are already working in clinical trials. Accumulating data demonstrate that etiology and the HCC microenvironment have a major influence on tumor growth and immune control. The improved knowledge of the specific molecular mechanisms involved is expected to provide evidence-based information critical for clinical management.
  • 421
  • 19 Apr 2022
Topic Review
Genetic Markers of Hepatocellular Carcinoma and Cholangiocarcinoma
Hepatocellular carcinoma (HCC) is the most common primary liver cancer with an increasing worldwide mortality rate. Cholangiocarcinoma (CCA) is the second most common primary liver cancer. In both types of cancers, early detection is very important. Biomarkers are a relevant part of diagnosis, enabling non-invasive detection and control of cancer recurrence, as well as in the application of screening tests in high-risk groups. Furthermore, some of these biomarkers are useful in controlling therapy and treatment selection. Detection of some markers presents higher sensitivity and specificity in combination with other markers when compared with a single detection. Some gene aberrations are also prognostic markers in the two types of cancers.
  • 560
  • 19 Apr 2022
Topic Review
MicroRNAs in Hepatic Ischemia–Reperfusion Injury
Hepatic ischemia–reperfusion injury (IRI) is one of the main factors for early allograft dysfunction (EAD), which may lead to graft rejection, graft loss, or shortened graft life in liver transplantation. Hepatic IRI appears to be inevitable during the majority of liver procurement and transportation of donor organs, resulting in a cascade of biological changes. The activation of signaling pathways during IRI results in the up- and downregulation of genes and microRNAs (miRNAs). miRNAs are ~21 nucleotides in length and well-characterized for their role in gene regulations; they have recently been used for therapeutic approaches in addition to their role as biomarkers for many diseases. Various miRNAs have been identified in association with hepatic IRI that either exaggerate or ameliorate the hepatic IRI. Altering targeted miRNA expression has great potential to reduce early graft dysfunction and improve patient outcome. Strategies to implement this approach have been studied using hepatic cell lines subjected to oxygen deprived conditions in vitro, as well as animal models after induction of hepatic IRI through warm ischemia in vivo. By studying the mechanisms of specific miRNAs, the up- or downregulation during hepatic IRI reveals whether that miRNA can ameliorate or exaggerate the metabolism and functions of the liver. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels can be used to indicate when liver injury is present and improve diagnosis accuracy along with miRNA biomarkers. The manipulation of miRNAs could have an influence on the inflammatory and oxidative stress pathways associated with hepatic IRI.
  • 357
  • 15 Apr 2022
Topic Review
Endoscopic Ultrasound-Guided Hepaticogastrostomy
Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) is widely performed worldwide for various benign and malignant biliary diseases in cases of difficult or unsuccessful endoscopic transpapillary cholangiopancreatography (ERCP). Furthermore, its applicability as primary drainage has also been reported. Although recent advances in EUS systems and equipment have made EUS-HGS easier and safer, the risk of serious adverse events such as bile leak and stent migration still exists. Physicians and assistants need not only sufficient skills and experience in ERCP-related procedures and basic EUS-related procedures such as fine needle aspiration and pancreatic fluid collection drainage, but also knowledge and techniques specific to EUS-HGS.
  • 1.0K
  • 08 Apr 2022
Topic Review
Cytotoxicity of Thiopurine Drugs in Inflammatory Bowel Disease
As the principal representatives of thiopurines, 6-mercaptopurine (6MP) and its prodrug azathioprine (AZA) are primary immunomodulating agents. They are used for example to manage inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), chronic inflammatory disorders of the gastrointestinal tract. Thiopurines were used to treat CD in the late 1960s and they are currently applied in around 60% of IBD patients.
  • 668
  • 31 Mar 2022
Topic Review
Liver Transplantation versus Liver Resection
For patients with early-stage hepatocellular carcinoma, it is important to know whether liver transplantation offers a survival benefit over liver resection. Patients receiving transplantation often have different characteristics in terms of their cancer stage and liver function compared to those being resected. This makes a comparison of the two treatment modalities challenging. This article presents a critical appraisal of the currently available literature. We not only provide a summary of the main results of individual articles but also describe their strengths and weaknesses, the relationships among them, and their trends. As a result, we suggest the regression discontinuity design for future studies that uses thresholds of a treatment guideline to help ensure that the groups are more comparable. 
  • 554
  • 29 Mar 2022
Topic Review
EUS and EUS-FNA
Endoscopic ultrasonography (EUS) has greater spatial resolution than other diagnostic imaging modalities. In addition, if gallbladder lesions are found and gallbladder cancer is suspected, EUS is an indispensable modality, enabling detailed tests for invasion depth evaluation using the Doppler mode and ultrasound agents. Furthermore, for gallbladder lesions, EUS fine-needle aspiration (EUS-FNA) can be used to differentiate benign and malignant forms of conditions, such as xanthogranulomatous cholecystitis, and collect evidence before chemotherapy.
  • 590
  • 29 Mar 2022
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