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| 1 | Endoscopic retrograde cholangiopancreatography associated pancreatitis:A 15-year review显示文摘The aim of this article is to review the literature regarding post-endoscopic retrograde cholangiopancreatography(ERCP) pancreatitis.We searched for and evaluated all articles describing the diagnosis,epidemiology,pathophysiology,morbidity,mortality and prevention of post-ERCP pancreatitis(PEP) in adult patients using the PubMed database.Search terms included endoscopic retrograde cholangiopancreatography,pancreatitis,ampulla of vater,endoscopic sphincterotomy,balloon dilatation,cholangiography,adverse events,standards and utilization.We limited our review of articles to those published between January 1,1994 and August 15,2009 regarding human adults and written in the English language.Publicat ions from the reference sections were reviewed and included if they were salient and fell into the time period of interest.Between the dates queried,seventeen large(> 500 patients) prospective and four large retrospective trials were conducted.PEP occurred in 1-15 in the prospective trials and in 1-4 in the retrospective trials.PEP was also reduced with pancreatic duct stent placement and outcomes were improved with endoscopic sphincterotomy compared to balloon sphincter dilation in the setting of choledocholithiasis.Approximately 34 pharmacologic agents have been evaluated for the prevention of PEP over the last f ifteen years in 63 trials.Although 22 of 63 trials published during our period of review suggested a reduction in PEP,no pharmacologic therapy has been widely accepted in clinical use in decreasing the development of PEP.In conclusion,PEP is a well-recognized complication of ERCP.Medical treatment for prevention has been disappointing.Proper patient selection and pancreatic duct stenting have been shown to reduce the complication rate in randomized clinical trials. | Kevin E Woods Field F Willingham | 2010 | World Journal of Gastrointestinal Endoscopy2010，2，5： | 20 |
| 2 | Mycophenolate mofetil for maintenance of remission in steroid-dependent autoimmune pancreatitis显示文摘Systemic corticosteroids represent the standard treatment for autoimmune pancreatitis with IgG4-associated cholangitis.For steroid-dependent disease,azathioprine has been used for maintenance of remission.Mycophenolate mofetil has been used for transplant immunosuppression and more recently for autoimmune hepatitis;however,there are no case reports to date on the use of mycophenolate mofetil in adult patients with autoimmune pancreatitis.A patient with IgG4-mediated autoimmune pancreatitis and IgG4-associated cholangitis refractory to steroids and intolerant of azathioprine was treated with mycophenolate mofetil,which inhibits de novo guanosine synthesis and blockade of both B and T lymphocyte production.Introduction of mycophenolate mofetil and uptitration to 1000 mg by mouth twice daily over a treatment period of 4 mo was associated with improvement in the patient's energy level and blood glucose control and was not associated with any adverse events.The patient was managed without a biliary stent.However,there was a return of symptoms,jaundice,increase in transaminases,and hyperbilirubinemia when the prednisone dose reached 11 mg per day.In the first report of mycophenolate mofetil use in an adult patient with IgG4-associated autoimmune pancreatitis and IgG4-associated cholangitis,the introduction of mycophenolate mofetil was safe and well-tolerated without adverse events,but it did not enable discontinuation of the steroids.Mycophenolate mofetil and other immunomodulatory therapies should continue to be studied for maintenance of remission in the large subset of patients with refractory or recurrent autoimmune pancreatitis. | Jamie B Sodikoff Steven A Keilin Sheila J Bharmal Melinda M Lewis Gottumukkala S Raju Field F Willingham | 2012 | World Journal of Gastroenterology2012，18，18： | 6 |
| 3 | Advances in endoscopic retrograde cholangiopancreatography cannulation显示文摘Endoscopic retrograde cholangiopancreatography is an important tool in the diagnosis and treatment of pancreatobiliary diseases.A critical step in this procedure is deep cannulation of the bile duct as failure of cannulation generally results in an aborted procedure and failed intervention.Expert endoscopists usually achieve a high rate of successful cannulation while those less experienced typically have a much lower rate and a greater incidence of complications.Prolonged attempts at cannulation can result in significant morbidity to patients,anxiety for endoscopists,unnecessary radiation exposure and inefficient patient care.Here we review the most common endoscopic techniques used to achieve selective biliary cannulation.Pharmacologic aids to cannulation are also discussed briefly in this review. | Emad Qayed Ashley L Reid Field F Willingham Steve Keilin | 2010 | World Journal of Gastrointestinal Endoscopy2010，2，4： | 1 |
| 4 | Role of pancreatoscopy in management of pancreatic disease:A systematic review显示文摘BACKGROUND Per-oral pancreatoscopy(POP) plays a role in the diagnosis and therapy of pancreatic diseases. With recent technological advances, there has been renewed interest in this modality.AIM To evaluate the efficacy and safety of POP in management of pancreatic stone disease and pancreatic ductal neoplasia.METHODS To determine the safety and efficacy of POP in the management of pancreatic diseases, a systematic search was conducted in MEDLINE, EMBASE and Ovid.Articles in languages other than English and case reports were excluded. All published case series were eligible. Data specific to POP were extracted from studies, which combined cholangiopancreatoscopy. Ten studies were included in the analysis of POP therapy for pancreatic stone disease, and 15 case series satisfied the criteria for inclusion for the role of POP in the management of pancreatic ductal neoplasia. The examined data were subcategorized according to adjunctive modalities, such as direct tissue sampling, cytology, the role of intraoperative POP, intraductal ultrasound(IDUS) and POP combined with image-enhancing technology.RESULTS The success rate for complete ductal stone clearance ranged from 37.5%-100%.Factors associated with failure included the presence of strictures, multiple stonesand the inability to visualize the target area. Although direct visualization can identify malignant and premalignant conditions, there is significant overlap with benign diseases. Visually-directed biopsies provide a high degree of accuracy,and represent a unique approach for tissue acquisition in patients with ductal abnormalities. Addition of pancreatic fluid cytology increases diagnostic yield for indeterminate lesions. Protrusions larger than 3 mm noted on IDUS are significantly more likely to be associated with malignancy. The rate of adverse events associated with POP ranged from 0%-35%.CONCLUSION Current evidence supports wider adoption of pancreatoscopy, as it is safe and effective. Improved patient selection and utilization of novel technologies may further enhance its role in managing pancreatic disease. | Tarun Kaura Field F Willingham Saurabh Chawla | 2019 | World Journal of Gastrointestinal Endoscopy2019，11，2： | 1 |
| 5 | Taking NOTES : Translu- menal flexible endoscopy and endoscopic surgery 显示文摘 | Willingham H Field F Brugge G | 2007 | Curr Opin Gastroenterology2007，23，5： | 1 |
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