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Fulltext Endoscopic ablation therapy for biliopancreatic malignancies

Roque J, Ho SH, Reddy N, Goh KL

Clin Endosc, 2015 Jan;48(1):15-9.
PMID: 25674521 DOI: 10.5946/ce.2015.48.1.15

Biliopancreatic malignancies such as cholangiocarcinoma (CCA) has notoriously been diagnosed late. As such most therapy have been palliative in nature. Cholangioscopy allows for an earlier diagnosis to be made. Brachytherapy with the insertion of catheter with iridium-132 seeds, percutaneously or through endoscopic retrograde cholangiopancreatography (ERCP) was the earliest ablative techniques used. It has been shown to have a beneficial effect only in prolonging survival. Photodynamic therapy (PDT) has also been used for several years. stenting with PDT versus stenting alone for unresectable CCA showed a marked survival benefit with the addition of PDT. However the most exciting endoscopic ablative modality appears to be intraductal radiofrequency ablation using the Habib catheter and device. Several case series have shown the effectiveness of this technique in ablating tumors. This technique is evolving and coupled with early diagnosis of CCA through cholangioscopy will allow for a curative therapy. The crux to the effective treatment of early cancerous lesions in the bile or pancreatic duct is the early diagnosis of such lesions. Effective endoscopic ablative therapy is now available with the advent of radiofrequency ablation probes that can be passed through the duodenoscope via ERCP.
Therapeutic efficacy of adjunctive photodynamic therapy in the treatment of denture stomatitis

Al-Ghamdi ARS, Khanam HK, Qamar Z, Abdul NS, Reddy N, Vempalli S, et al.

Photodiagnosis Photodyn Ther, 2023 Jun;42:103326.
PMID: 36773753 DOI: 10.1016/j.pdpdt.2023.103326

BACKGROUND: The present report assessed the efficacy of curcumin-mediated photodynamic therapy (CUR-mediated PDT) as an adjunct to antifungal gel treatment by evaluating the salivary interleukin-6 (IL-6) and matrix metalloproteinases-8 (MMP-8) levels together with Candida species counts in denture stomatitis (DS) patients.
METHODS: In total, 50 DS subjects were randomly categorized into 2 groups: Group-1: subjects who received the antifungal gel treatment and Group-2: participants who received CUR-mediated PDT. The Sabourad Dextrose Agar and CHROMAgar were utilized for evaluating Candida species counts, while the Enzyme-Linked Immunosorbent Assay was employed to estimate the salivary levels of IL-6 and MMP-8. All clinical evaluations were performed at the baseline, 1 month, and 2 months.
RESULTS: In total, group-2 subjects showed a significant decrease in Candida albicans (C. albicans) counts on both follow-ups (i.e., 1-month and 2-month) than group-1 participants. C. krusei count also reduced in group-2 subejcts than group-1 participants at the 2nd follow-up as compared to the baseline, nevertheless, a slight increase in C. krusei count was noticed in group-2 subjects at the 2nd follow-up than the 1st follow-up. The salivary IL-6 and MMP-8 levels in both groups reduced significantly at both follow-ups than the baseline. According to the stepwise logistic regression analysis, no statistically significant correlation was observed between Candida species count and other parameters such as age and gender of the patient, duration of DS, and frequency of treatment(s).
CONCLUSION: CUR-mediated PDT is an efficaciousness therapeutic modality for alleviating Candida species counts on the surface of denture and the palatal mucosa, as well as improving the salivary IL-6 and MMP-8 levels in DS patients.
Fulltext A new biodegradable stent in bilio-pancreatic diseases: A prospective multi-center feasibility study

Pérez-Cuadrado Robles E, Lakhtakia S, Othman H, Tewethia HV, Yaacob N, Jarmin R, et al.

Rev Esp Enferm Dig, 2022 Jan 11.
PMID: 35012320 DOI: 10.17235/reed.2022.8451/2021

Introduction Biodegradable stents of various designs are reportedly used in pancreato-biliary conditions with promising results. Their major advantage is the avoidance of a repeat endoscopic procedure for stent removal thereby reducing overall cost along with ERCP associated adverse events. To evaluate the feasibility and safety of a new biodegradable stent in patients with pancreato-biliary diseases. Methods Prospective multicenter pilot study. All consecutive patients 18 years-old who underwent biliary or pancreatic stenting using the new biodegradable Archimedes stent were included. There were three biodegradation profiles. Technical and clinical success, feasibility and safety were assessed during a pre-established follow-up schedule. Results Fifty-three patients (mean age: 48.54±19.29, 66% male) having biliary (n=29, 54.7%%) or pancreatic (n=24, 45.3%) indications were included. The distribution of stents used according to degradation properties were as follows: fast (n=11, 20.8%), medium (n=16, 30.2%) and slow (n=26, 49.1%). The technical and clinical success were 100% and 77.8%. Thirty-five patients were followed for a median of 26 weeks (range: 4-56, 66%). There were 9 procedure-related adverse events (17%), all mild, including one uneventful stent-related event (external migration). Conclusion The biodegradable Archimedes stent placement is feasible and safe in pancreato-biliary diseases.
An updated Asia Pacific Consensus Recommendations on colorectal cancer screening

Sung JJ, Ng SC, Chan FK, Chiu HM, Kim HS, Matsuda T, et al.

Gut, 2015 Jan;64(1):121-32.
PMID: 24647008 DOI: 10.1136/gutjnl-2013-306503

OBJECTIVE: Since the publication of the first Asia Pacific Consensus on Colorectal Cancer (CRC) in 2008, there are substantial advancements in the science and experience of implementing CRC screening. The Asia Pacific Working Group aimed to provide an updated set of consensus recommendations.
DESIGN: Members from 14 Asian regions gathered to seek consensus using other national and international guidelines, and recent relevant literature published from 2008 to 2013. A modified Delphi process was adopted to develop the statements.
RESULTS: Age range for CRC screening is defined as 50-75 years. Advancing age, male, family history of CRC, smoking and obesity are confirmed risk factors for CRC and advanced neoplasia. A risk-stratified scoring system is recommended for selecting high-risk patients for colonoscopy. Quantitative faecal immunochemical test (FIT) instead of guaiac-based faecal occult blood test (gFOBT) is preferred for average-risk subjects. Ancillary methods in colonoscopy, with the exception of chromoendoscopy, have not proven to be superior to high-definition white light endoscopy in identifying adenoma. Quality of colonoscopy should be upheld and quality assurance programme should be in place to audit every aspects of CRC screening. Serrated adenoma is recognised as a risk for interval cancer. There is no consensus on the recruitment of trained endoscopy nurses for CRC screening.
CONCLUSIONS: Based on recent data on CRC screening, an updated list of recommendations on CRC screening is prepared. These consensus statements will further enhance the implementation of CRC screening in the Asia Pacific region.
Fulltext Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018

Sung JJ, Chiu PW, Chan FKL, Lau JY, Goh KL, Ho LH, et al.

Gut, 2018 10;67(10):1757-1768.
PMID: 29691276 DOI: 10.1136/gutjnl-2018-316276

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the 'gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement.
Fulltext Management of patients on antithrombotic agents undergoing emergency and elective endoscopy: joint Asian Pacific Association of Gastroenterology (APAGE) and Asian Pacific Society for Digestive Endoscopy (APSDE) practice guidelines

Chan FKL, Goh KL, Reddy N, Fujimoto K, Ho KY, Hokimoto S, et al.

Gut, 2018 03;67(3):405-417.
PMID: 29331946 DOI: 10.1136/gutjnl-2017-315131

This Guideline is a joint official statement of the Asian Pacific Association of Gastroenterology (APAGE) and the Asian Pacific Society for Digestive Endoscopy (APSDE). It was developed in response to the increasing use of antithrombotic agents (antiplatelet agents and anticoagulants) in patients undergoing gastrointestinal (GI) endoscopy in Asia. After reviewing current practice guidelines in Europe and the USA, the joint committee identified unmet needs, noticed inconsistencies, raised doubts about certain recommendations and recognised significant discrepancies in clinical practice between different regions. We developed this joint official statement based on a systematic review of the literature, critical appraisal of existing guidelines and expert consensus using a two-stage modified Delphi process. This joint APAGE-APSDE Practice Guideline is intended to be an educational tool that assists clinicians in improving care for patients on antithrombotics who require emergency or elective GI endoscopy in the Asian Pacific region.