Commercially available covered esophageal stents
\r\n\tHydrogen gas is the key energy source for hydrogen-based society. Ozone dissolved water is expected as the sterilization and cleaning agent that can comply with the new law enacted by the US Food and Drug Administration (FDA). The law “FDA Food Safety Modernization Act” requires sterilization and washing of foods to prevent food poisoning and has a strict provision that vegetables, meat, and fish must be washed with non-chlorine cleaning agents to make E. coli adhering to food down to “zero”. If ozone dissolved water could be successively applied in this field, electrochemistry would make a significant contribution to society.
\r\n\r\n\t
\r\n\tOxygen-enriched water is said to promote the growth of farmed fish. Hydrogen dissolved water is said to be able to efficiently remove minute dust on the silicon wafer when used in combination with ultrasonic irradiation.
\r\n\tAt present researches on direct water electrolysis have shown significant progress. For example, boron-doped diamonds and complex metal oxides are widely used as an electrode, and the interposing polymer electrolyte membrane (PEM) between electrodes has become one of the major processes of water electrolysis.
\r\n\t
\r\n\tThe purpose of this book is to show the latest water electrolysis technology and the future of society applying it.
Stenting is well established in the non-operative management of many sites, including, vascular system, biliary tree and tracheobronchial tree. Within the upper gastrointestinal tract, stenting is most frequently employed in oesophagus, but currently the role of stenting in stomach and duodenal has widely gained acceptance.
\nThe first stent widely used in the esophagus was constructed from silicon rubber tube (Silastic, Dow Corning. Midland, MI). In 1959, Celestine described the use of plastic endoprosthesis introduced through laparotomy via an open gastrostomy to palliate the esophageal stricture but it was associated with high complication as high as 45%.[1] In 1970s, Atkinson introduced an endoscopically placed plastic endoprosthesis[2], which became popular over the years as it is associated with fewer complications despite smaller internal diameter. (Figure 1)\n
\nHowever, the invention of the self- expanding metal stent (SEMS) (Figure 2) marked the new era of modern esophageal stenting as it is associated with higher success rate, fewer complications and ease of insertion. The first description of the endoscopic placement of an expanding metallic spiral stent was made by Frimberger in 1983.[3] There are currently at least eight different types of metallic stent on the market, covered and uncovered, some of which have anti-reflux valves.
\nThe use of endoscopic stent has an increasing role in upper gastrointestinal tract diseases as it offers immediate relief of obstruction and immediate coverage for anastomotic leak in a minimally invasive approach. Recently various self-expanding metal or plastic stents have been developed for palliation of malignant obstruction of the gastrointestinal tracts. The major impact of these newer stents relates to the ease of insertion due to smaller delivery system with fewer complications and self –expandable property. However, the physician‘s perception of ease of placement has major influence in choosing the type of stent to be used.[4]
\nA Plastic stent which is successfully place endoscopically through the esophageal cancer
A retrievable self-expanding metallic stent
This review mainly focuses on the current status of self-expanding stent placement in esophageal and gastric disease, as well as considering the suitable candidate, side-effect, potential complications in relation to our experience of endoscopic stenting in various upper gastrointestinal tract disease, particularly in the management of post-operative complication.
\nThe stents are broadly classified into metallic and plastic stent. Metallic stents are made from nitinol (nickel-titanium alloy) or stainless steel and all are self-expanding metallic stents (SEMS). Although the metal used in this stent are made to be inert, resistant to erosion and non-allergenic but when the stent coils embedded into the mucosa, they still could trigger mild inflammatory reaction with fibrosis formation that reduce the risk of migration but it makes its removal difficult. The nitinol stent has thermal shape memory feature that enables it to expand at body temperature and adapts to the shape of a particular lesion. The initial type of metallic stent was uncovered but because of issues of tumour in-growth through the stent and tissue reaction, thus the current available stent is fully or partially covered. Current design of covered stent incorporates features such as partly uncovered portion, proximal flaring, placing the covering material on inside, to reduce the migration rate. The materials used for covered stent are silicone or plastic. However, the risk of stent migration is higher in the covered stent especially in high risk area such as distal esophagus. The covered stent is useful in benign lesion as it is easier to remove once the stricture expands. Stents are available in a wide variety of lengths and diameters. The most commonly available used stents are usually the 10-12cm long, 18- 21 mm diameter, covered SEMS. Besides, the availability of proximal release stent allows the stenting of very high esophageal lesion much easier with precise positioning under endoscopic guidance without flouroscopy[5] (Figure 3)\n
\nTwo types of stent release mechanism
The self-expanding plastic stent (SEPS) is the latest development of stent design and it is indicated for esophageal stenosis such as refractory benign strictures and malignant esophageal stricture. Polyflex esophageal stent (Boston Scientific, USA) is the only stent on the market which is indicated for benign esophageal stricture and can be placed temporary up to 9 months according to manufacture guideline. However, the utility of this device is constrained by the requirement of a relatively large (12-14 mm) rigid introducer, manual assembly and the necessity of fluoroscopic guidance using a wire for appropriate positioning.
\nThe important type of stents that are available on the market are given in Table 1\n
\n\n Name \n | \n\n Manufacturer\n | \n\n Material \n | \nDiameter (mm) | \n Length (mm) | \n \n Delivery system size (mm)\n | \n\n Special features\n | \n
Polyflex | \nBoston Scientific, USA | \nPolyester, silicone covered | \n16-21 | \n90-150 | \n12.0-14.0 | \nNeed manual assembly prior to stent placement. Indicated for benign esophageal stricture | \n
Niti-S | \nTaewoong Medical, Korea | \nNitinol wire, silicone covered | \n16-20 | \n60-150 | \n5.8-6.5 | \nFully covered. Proximal/ distal release available. Retrievable if misplaced. Proximal lasso. Antireflux variant available | \n
UltraflexTM\n | \nBoston Scientific, USA | \nNitinol wire, polyurethane covered | \n18-23 | \n100-150 | \n6 | \nPartially covered at mid-portion. Ideal for upper 1/3 esophagus. Little expansile force. Not intended to be repositioned of removed once deployed. Large proximal flares | \n
Z-stent ® | \nWilson-Cook Medical,USA | \nStainless steel, polyurethane covered | \n18 | \n80-140 | \n10 | \nNon-shortening partially covered stent. Preloaded on a Z-speed introduction system | \n
BonastentTM\n | \nStandard Sci-Tech, Korea | \nNitinol wire, silicone covered | \n18 | \n60-150 | \n5 | \nFully covered. Repositionable if misplaced less than 50% of its length. Small delivery diameter (5 mm) Proximal and distal lasso,.Antireflux variant available | \n
Choo stent TM\n | \nM.I.Tech, Korea | \nNitinol wire, silicone covered | \n18 | \n60-170 | \n6 | \nRetrievable if misplaced. Proximal and distal lasso. Antireflux variant available | \n
Alimaxx-ESTM\n | \nMerit Medical system, USA | \nNitinol wire, polyurethane covered | \n12-14 | \n70-120 | \n7.4 | \nFully covered. Antimigration struts. Proximal suture knot for removal | \n
Commercially available covered esophageal stents
The aim for stenting is the palliation of malignant dysphagia in esophageal or gastric cancer in patients whom are not candidate for surgical resection due to extensive local or metastatic disease or poor functional status. Trecheo-esophageal fistula due to locally advanced cancer which leads to recurrent aspiration pneumonia is a good indication as studies has shown the used of covered stent may increase survival as compared to other therapies.[6]
\nThe used of covered stent in benign esophageal lesions such as leak or perforation especially in high risk patients too precarious for major operation, has gain increasing acceptance in upper GI surgery.[7] In this selected group of patient, the choice of stent is utmost important as the stent must be left long enough for the leak to heal but without complication of difficult removal later on. The new designed fully covered stent such as SEMS (Nitinol coved stent) and SEPS (Polyflex) are particular suitable in this situation. Most stents are left for 2 to 3 months for the perforation to heal.
\nThe use of stent in benign esophegeal stricture has also gain popularity in recent years.[8] Those refractory esophageal strictures with failure of serial dilatation probably are the best candidate in this indication.[9] Placement of fully covered retrievable stent after dilation as non-permanent dilator and remove it after 1 to 2 months after the fibrosis has stabilised.
\nThere are no real contraindications for stenting due to improvement of the stent design. Traditionally, it is not advisable to stent in high esophageal lesion due to risk of aspiration, pain or risk of tracheal compression. However, with the availability of new design and proximal release stent which allow accurate endoscopic placement make the treatment of this lesion a possibility.[10] In patient with advanced esophageal cancer with very short of expectancy (< 4 weeks) should probably not considered a candidate for stenting.
\nInformed consent should be obtained prior to stent placement especially the information regarding the expected benefit, risk and possible short and long term complications should be properly conveyed to patients
\nThe use of stenting has been shown to improve quality of life indices.[11, 12] The improvement of dysphagia has been the objective of the esophegeal stenting. The dysphagia score is used to assess the degree of dysphagia. (Table 2)[13] Most published series showed the overall immediate technical success rate in 100%, with improvement of dysphagia score approaching 90%.[12] The ability of oral intake to allow gastronomic pleasure is also another benefit, which not only improve the quality of life but possibly the nutrition status of the patient.
\n\n Dysphagia score\n | \n\n Degree of dysphagia\n | \n
0 | \nNo dysphagia | \n
1 | \nAble to swallow some solid food only | \n
2 | \nAble to swallow semi-solid only | \n
3 | \nAble to swallow liquids only | \n
4 | \nComplete dysphagia | \n
The dysphagia score
Minor procedure complications which lead to morbidity were seen up to 40% in various series.[14, 15] Intra-procedure complications such as aspiration, sedation risk, malposition of the stent, bleeding and perforation could occur. Early complications may include chest pain, bleeding or tracheal compression. Late complications such as stent migration, tumour overgrowth or ingrowth[16-18], delayed perforation, food bolus impaction, fistula formation may occur. However, fistula and perforation due to stent insertion are uncommon. Early chest pain occur in most patient, but prolonged pain only occur in fewer than 13% of patients.[18] Pain is most severe with high stricture and when large diameter of stent is used.[19] The migration rate for those uncovered stent is less than 3% in esophagus, but increases to 6% if placed across the cardia.[13, 17] The migration rate of covered stent is generally up to 30%, especially when positioned across cardia.[17, 18, 20] The migrated stent should be retrieved endoscopically as it may cause small bowel obstruction or perforation.[21]
\nBefore placement of the stent, a barium swallow should be obtained to delineate the site and length of the esophageal stricture. The stent could be deployed under endoscopic visualization, fluoroscopic guidance with the aid of guide wire and sometime require pre-dilatation of the lesion. It is especially helpful to have a nurse who experienced in complex endoscopic procedure to facilitate the success of stent deployment. Esophageal dilation is usually done before stent insertion but it is not a pre-requisite for successful stent deployment. The precise requirement of dilatation generally depends on the type of stent to be used, dilatation to no more than 12mm is recommended, which will facilitate introduction of the delivery system and allow rapid expansion of the stent. However, most people advocate do not pre-dilate the stricture as the stricture itself with hold the stent to reduce the risk of migration.
\nDuring procedure, the patient lies in left lateral position, Xylocaine spray is applied to the pharynx, the patient is sedated with an intravenous agent such as midazolam and analgesia is provided such as fentanyl. If the endoscope is managed to transverse the lesion, the proximal and distal border of the lesion are marked using radio-opaque markers, endoclips or contrast such as lipoidal agent. The stent is introduced over the guide wire until the marking on the stent are placed within 2cm of more margins proximal and distal to the lesion. Final adjustment is made under fluoroscopic guidance to ensure that the stent adequately covers the Lesion’s marking. By slowly retracting the outer sheath of the delivery system while maintaining the position of the inner shaft, the stent is deployed under fluoroscopic guidance. It is important that the inner shaft of the delivery system is held stationary against the body while deployment and not allowed to move, as any movement may cause malposition of the stent. Endoscopic visualization of the stent placemen also could be performed, especially with the aid of transnasal endoscopy which allows direct visual control of the esophageal stent placement without fluoroscopy.[22] After full deployment of stent and the expansion of the stent is verified fluoroscopically, the olive tip and the delivery system should be removed with care to prevent the dislodgment of the stent. For those stent that is placed too distally, a strong forcep could be used to hold the proximal lasso and the traction of it allow the stent narrows and be positioned more proximally. (Figure 4) Immediately after the procedure, non-ionic contrast medium is introduced through the catheter to look for any procedural related complications, especially esophageal perforation and to ascertain the stent patency. Endoscopy also can be done to ascertain the position of the stent but the endoscope should not be passed through the stent to prevent dislodgment of the stent. Chest x-ray should be carried out later to verify the position of the stent to look for sign of perforation.
\nPatient should stayed overnight for post-procedure monitoring. Some patients might complain of chest discomfort or chest pain which could be relieved with simple analgesia. Occasionally the pain is so severe which needs stent removal.
\nPatient with stent must modify their diet to prevent food impaction that lead to stent occlusion. Diet should be introduced as tolerated. Patient with stent placed without anti-reflux valve should be started on a high dose proton pump inhibitor indefinitely to prevent gastro-esophageal reflux. Stent occlusion due to food impaction could be dislodged endoscopically but those occlusion arises due to tumour overgrowth necessitate co-axial stenting on previous stent or laser ablation.
\n\n Technical points to consider\n
\nCovered stent should be used for tumour with high risk of fistula formation and to prevent in-growth of tumour through the metal mesh.
Stents with antireflux valve should be considered if position across the gastroesophageal junction due to disabling gastroesophageal reflux.[20, 23]
The proximal margin of the stent could be hold to mucosal tissue using endoclips to prevent stent migration.[24][25](Figure 5)\n
The partially migrated stent could be fixed with another covered stent, placed coaxially overlapping the upper portion of the migrated stent.
Those SEMS that is difficult to be removed due to tissue in-growth through the uncovered portion, a covered SEPS could be inserted overlapping the SEMS to press the tissue out of the stent mesh and causing pressure necrosis. Both of the stent could be removed few days later.[26, 27]
The proximal lasso could be retracted with strong grasper resulting narrowing of the stent body for easier removal.
Use of endoclips to hold the proximal margin of stent to prevent stent migration.
The role of stenting in upper GI disease can be broadly dived into:
\nEsophagus:
\nStents used in esophageal malignancy
Stents used in benign esophageal lesion such as stricture or perforation
Stents used in post-operative complication
Stomach:
\nStents used in gastric outlet obstruction
Stents used in bariatric surgery
Most patients with upper GI cancer especially esophageal cancers presented late with locally advanced or metastatic disease, which preclude them form surgical resection.[28] Patients may have no symptoms until the diameter of the esophageal lumen has been reduced by 50% resulting in late presentation and poor prognosis.[29] However, the problem of dysphagia, vomiting and malnutrition will severely impair the quality of life of these patients. A variety of endoscopic treatment modalities such as thermal ablation, brachytherapy, photodynamic therapy, chemical injection, argon beam therapy and endoluminal stenting have been utilized with these objectives in mind, with options determined by the location and size of the tumour, as well as the patient\'s expected prognosis.[29] The use self-expanding stent in this kind of patients as a form of palliation,[30] instead of surgical bypass, is particular helpful in relieving the obstruction while allow them to eat, manage their oropharyngeal secretions, reduce aspiration risk, and improve the nutrition status.
\nThe esophageal stenting in malignancy can broadly divided into two situation:
\nPalliation in advanced cancer
Temporary stenting for patient undergoing neoadjuvant therapy
\n Palliation in advanced cancer\n
\nSEMS placement is a safe and effective technique with good symptom palliation in advanced esophageal cancer.[17] Case series showed that the dysphagia score improved faster, 85% within 2 week as compare to radiotherapy which the onset of palliation was slower, with only 50% of patients palliated at 2 weeks.[31] Successful stent placements are achieved in up to 98% cases.[32] In palliation of malignant esophagorespiratory fistula or perforation, covered metallic stent have a clinical success rate of 95-100%.[33, 34] (Figure 6) Sometime, fistulas close to the upper esophageal sphincter may be closed with placement of parallel covered metallic stents in the esophagus and trachea.[35] The quality of life also reported to improve after palliative esophageal stenting. [12] Another major problem of esophageal stenting in advanced cancer is the tumour overgrowth which leads to recurrent dysphagia in patient who is survives long enough.[16, 36] This can be easily intervened with co-axial stent as overlapping stent. [36](Figure 7)\n
\nA locally advanced esophageal cancer with tracheoesophageal fistula presented with recurrent aspiration pneumonia and treated successfully with a covered esophageal stent for symptomatic relief.
Tumour over growth at the distal end of the covered stent which was treated with another co-axial covered stent across the previous old stent to relieve the obstruction.
Temporary stenting before neoadjuvant therapy
\nDue to malignancy induced cachexia and dysphagia, nutrition compromise is extremely common for those patients undergoing neoadjuvant chemotherapy or radiotherapy, which result in poorer outcome after surgery. The insertion of stent in this setting has been reported to have higher stent related complication such as migration or perforation and also difficulty of surgery later on. However, with the advent of fully covered SEMS with much reduced complication rate has led to renew interest in this indication.
\nThe use of stenting in neoadjuvant setting results in improvement of dysphagia score and nutrition has been reported in several studies.[37-39] Although it is safe with effective palliation of symptom with minimal complication, the migration does occur up to 48% especially in esophageal stenting across the gastroesophageal stenting.[40] However, the migration of stent is usually indicating a positive response to neoadjuvant therapy and the stent could easily be retrieved prior to surgery.[38] The fully covered SEMS do not appear to compromise surgical resection. [40]There is no increased risk of peri-operative complication due to stent in all these series.
\nBenign esophageal stricture in the esophagus can be due to a variety of causes such as reflux esophagitis, corrosive ingestion, post-radiation exposure, etc. The initial treatment of choice is serial dilatations. However, up to 30-40% of these strictures will recur and require repeated dilatation or even surgery.[41, 42] It is particularly important to differentiate between esophageal strictures that are simple (focal, straight strictures with a diameter that allows endoscope to passage) and those that are more complex (long, >2 cm, tortuous strictures with a narrow diameter).[9] These complex strictures are considered refractory when they cannot be dilated to an adequate diameter. The concept of using esophageal stent as a non-permanent dilator provides an alternative treatment of esophageal stricture instead of surgery.[43] The use of non-removable metal stents in benign esophageal stricture has been complicated by hyperplastic tissue reaction, tissue ingrowth, stricture formation and erosion into the surrounding organ. Therefore, removable fully covered self-expanding metal stent is recommended although the problem of tissue reaction or stent migrations also occur with these devises.[44]. The suggested stent of choice to be used in benign esophageal stricture is Polyflex stent (Boston Scientific, USA) as it causes less tissue reaction. This is the only SEPS available in the market and is approved for refractory benign stricture and treatment of trachea-esophageal fistula. This is self-expanding plastic stent made of polyester mesh that is fully covered with a silicone membrane with proximal flare to prevent migration. A systemic review showed the Polyflex is moderate effective, achieving dilatation free remission in 52% cases and achieves lower success rate when dealing with upper esophageal stricture.[8] This could due to more complex anatomy in upper esophagus which prevents effective remodelling of the stricture by SEPS. A recent meta-analysis showed that the efficacy of self-expanding covered stent placement in benign refractory strictures is only 46.2 % and associated with migration rate of 26.4 %.[45] Our early experience with this stent has been quite positive for the management of recurrent and refractory benign stricture. (Figure 8 and 9)
\nA 35 years old lady developed a short segment benign esophageal stricture at mid esophagus after cardiac surgery for closure of VSD and heart valve replacement. Multiple oesophageal dilatation had failed to relieve the obstruction. A polyflex stent was inserted temporary as non-permanent dilator with good symptomatic relief.
A high pharyngoesophageal stricture after laryngopharyngectomy treated with a proximal release fully covered Nitinol stent (TaewoongNiti-S, Korea) under endoscopic control.
Anastomotic leak in upper GI surgery is a serious complication especially when the leak is within the thoracic cavity with septic consequences. The sites of leak most commonly encountered are gastroesophageal or gastrojejunostomy or esophagojejunostomy anastomosis. Early intervention from the subtle clinical clues is the key to successful management. Traditionally, the management has most often consisted of re-operation for repair and drainage, prolonged hospitalisation and sometime necessitate resection of diversion which requires subsequent restorative surgery.
\nThe use of endoluminal stenting for esophageal leak instead of surgical intervention has been reported with good outcome.[46, 47] In a large series, up to 77.6% of patients with post-operative leak responded to stenting with a median duration of SEMS treatment of 83 days and the stent should be removed after 6 weeks.[48]Polyflex of SEPS type has also been used with good success rate.[49]
\nThe role of endoluminal stenting in Peri-operative setting could be considered in situations such as:
\nThose patients with an anastomotic leak that are diagnosed late in the course and in whom operative closure is not feasible.
Those patients with an anastomotic leak with medical condition who are too precarious for surgical intervention.
Those patients with chronic fistula due to anastomotic failure.
However, It has been shown that those anastomotic leak located in cervical esophagus, gastroesophageal junction, esophageal injury longer than 6 cm or an anastomotic leak associated with a more distal conduit leak tend to be not treated effectively with stenting. Therefore, traditional operative repair suggested to be used as initial therapy.[50]
\nIn our practice, the authors found that the fully covered retrievable stent and with large diameter up to 21-23mm should be used for effective sealing of the defect. There is a problem of peri-stent leak especially from the jejunal limb in some cases. However, it is usually a contained leak which could be drained percutaneously under image guidance. (Figure 10) Sometime, another stent has to be inserted across the previous stent for effective sealing. The SEPS is preferred to be used as it causes less tissue reaction and ease to be removed later. The inserted stent should be removed within 2 months and sometime we left it permanently in patient with advanced cancer. Similarly, post-operative anastomotic stricture could also be managed effectively with stent. Leakage at the anastomosis and stapler anastomosis were found to be the risk factors for the development of strictures.[51, 52] Improvement in quality of life and relief of dysphagia could be achieved when dilatation of the stricture fails. In conclusion, endoluminal stenting is a minimally invasive therapy of anastomotic complication which is a safe and effective. It results in rapid leak occlusion and avoids morbidity of re-operative repair.
\nPost esophagectomy anastomotic leak. Two leak points at the anastomotic site located at both lateral corner of the staple line. A fully covered Polyflex stent, measured 21 mm diameter and 90 mm length inserted. The leak was successfully contained and a percutaneously drain was inserted into the chest cavity for external drainage.
Esophageal perforation is most commonly iatrogenic induced but occasionally it occurs spontaneously such as in Boerhaeve’s syndrome. It carries a dismal prognosis due to mediastinitis and severe sepsis. Esophageal stenting has been shown to be effective in managing the leak as a less morbid intervention if compared with surgery.[48, 53] Several case series showed an effective healing leak rate up to 90%.[48, 54] The key to success outcome is prompt recognition of leak with rapid esophageal stenting immediately after the perforation and adequate debridement and lavage of the thoracic cavity. (Figure 11)\n
\nThe usual causes of gastric outlet obstruction are due to tumour in gastric antrum, duodenal stricture, or obstruction secondary to direct invasion or extrinsic compression from pancreatic carcinoma. The aim in palliation in patients with malignant gastric outlet obstruction is to reestablish oral intake by restoring gastrointestinal continuity. Gastric outlet obstruction was traditionally treated with surgical gastroenterostomy and stenting is usually reserved for patients who are not fit for surgery.
\nProlong nasojejunal tube feeding or percutaneous jejunostomy to provide nutrition is not an ideal palliation treatment in those patients not fit for surgical bypass as the tube will cause significant discomfort in these terminal ill patients. Therefore, internal stenting of the lesion will offer the best method of palliation for these patients, apart from relieve of obstruction but also able them to resume oral intake. (Figure 12) Stents can be successfully deployed in the majority of patients.[55] Stent placement appears to lead to a shorter time to symptomatic improvement, shorter time to resumption of an oral diet, and shorter hospital stays as compared with surgical options.[56] However, surgical bypass results in better long-term outcomes as compared to internal stenting. A recent randomised controlled trial showed that despite slow initial symptom improvement, gastrojejunostomy is associated with better long-term results and is therefore the treatment of choice in patients with a life expectancy of 2 months or longer.[57] Currently, the metallic uncovered stents are commonly used to prevent the risk of migration.
\nAnother interesting use of stent in locally advanced gastric cancer such as linitis plastica type which may cause gastroesophageal and gastric outlet obstruction. The placement of an extra long, covered stent traversing the cardioesophageal junction up to duodenum will provide symptomatic relief (Figure 13). The stent not only provides some degree of peroral intake but is able to relieve of the gastric outlet obstruction probably due to peri-stent flow.
\nLower esophageal perforation occurred after endoscopic dilatation and the defect was immediately stented under fluoroscopic control.
Barium meal showed good of barium trough the through the pyloric obstruction after internal stenting.
An extra long 23cm, fully covered Nitinol stent (Taewoong Niti-S, Korea) deployed crossing the gastroesophageal junction and pylorus in a’ linitis plastic type’ gastric cancer to bypass the obstruction.
Bariatric surgery has become an effective solution to treat morbid obesity. Laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass carry a mortality rate of 0.1% and 0.5%, respectively. [58] Therefore, surgery on this high risk group of patients can be dangerous especially leak occur and carry a high risk of mortality if not detected and treated expediently. The leak usually arises from stapler line failures due to surgical technique, ischaemia and patient comorbid conditions. In sleeve gastrectomy, the leak site is usually found in the upper sleeve near the gastroesopheal junction.[59] Recently, the placement of long endoluninal stent have been demonstrated to be safe and effective to exclude the leak site, allowing oral intake and speeding healing.[59, 60]
\nThe recent development of bariatric surgery is the placement of the EndoBarrier duodenal jejunal bypass liner which appears to be a promising, safe and effective method for facilitating weight loss.[61] The EndoBarrier is a plastic flexible tube which is endoscopically placed in the duodenal bulb, directly behind the pylorus. It extends from the duodenum to the proximal jejunum. Recent studies have demonstrated significant weight reduction in comparison to control-diet patients.[62] However, the lack of long term result and small samples size studies call for a need for longer randomised controlled trial before its widespread use.[63]
\nAll the stent are equally effective in achieving symptomatic palliation in malignant dysphagia. The type of stent chosen is usually based on subjective physician\'s preference. However, the stents vary in features such as the ease of insertion, removability, migration and occlusion rates. Covered and uncovered stents have different functional characteristics and stent type must be selected on an individual basis. A recent meta-analysis suggests that SEMS are superior to SEPS in terms of stent insertion-related mortality, morbidity, and quality of palliation.[4] The uncovered variety is disadvantaged by high rate of tumour in-growth.[4] The currently available SEPS, Polyflex is cumbersome to use due to its larger introduced system and higher rate of migration. However, the SEPS is equally effective in relieving dysphagia and useful in case of tissue ingrowth/overgrowth after SEMS placement.[64]
\nStenting in upper gastrointestinal disease is now fully established in the management advanced cancer and complication due to surgery such as stricture or anastomotic leak. It offers a minimally invasive approach to address obstructive symptom and improve quality of life of patients. In difficult cases, a multi-disciplinary team approach involving surgeon, gastroenterologist and radiologist is the corner stone of successful endoscopic palliative therapy.
\nContinuous innovation of new stent will lead to higher technical and clinical success rates of endoscopic stenting, while reducing complication rates. Therefore, stenting will become much simpler and more convenient to use for physician but also more comfortable for the patients. Future development in stenting includes biodegradable stents for benign disease to reduce stent related complication [65] and radioactive [66]or drug-eluting[67] stents for malignant disease which will decrease tumour growth and sustain the stent patency.
\nThe authors wish to thanks Professor Dato’ Dr K L Goh, Head of Gastroenterology and Hepatology, University of Malaya for letting us to use some of his personal photo collection in preparation of this manuscript.
\nThe mankind has relied on different sources of energy during its economic development throughout the centuries. Whereas coal has been the main energy source in the nineteenth century, oil was in twentieth one. The possible scenarios for remediation of greenhouse effect due to carbon dioxide released by energy production and industry are rendered to minimization of emissions and its recycling. The latter is accomplished by the production of energy sources and chemicals of practical importance from carbon dioxide.
The emission minimization consists in two approaches: replacement of the fossil fuels by renewable ones (solar, wind energies, biomass, etc.) or improvement of energy efficiency in all human activities in different ways. The distribution of energy sources for the European Union for the year 2016 is shown in Figure 1. One can see that the share of renewables is bigger than the powerful nuclear energy with a leading role in energy production. The biggest part (more than 60%) of the renewable energy sources is assigned to the biomass and waste utilization.
Production of primary energy, EU-28, 2016 (% of total, based on tons of oil equivalent). Source: Eurostat (nrg_100a) and (nrg_107a) [1].
One of the ways to cope with the problem of carbon dioxide emissions is to close the carbon cycle using renewable fuels from presently grown biomass, by recycling the released carbon dioxide by the present vegetation by photosynthesis. This is the philosophy of biomass utilization as energy source. The most spread biofuels in the present period are biogas, produced by anaerobic digestion of organic waste, bioethanol, produced from cereals and/or lignocellulosic residues and biodiesel, produced by trans-esterification of lipids with methanol or ethanol.
In this review, we shall concentrate ourselves to the application of biogas as renewable energy source and also as a feedstock for the production of chemicals and other fuels.
Biogas is produced by anaerobic digestion of organic matter of natural origin [2, 3, 4]. The main advantage of this process consists in the combined environmental and energy effect.
Biogas consists mainly of methane, carbon dioxide, and traces of hydrogen sulfide and mercaptanes, as well as residual amounts of oxygen and nitrogen. Small amounts of ethane and hydrogen are possible too. Biogas is obtained by anaerobic digestion of organic waste of biologic origin. The most exploited ones are of agricultural origin (manure, poultry litter, hay, and straw) [5], from food industry, stillage from ethanol production [6], landfill gas, activated sludge from wastewater treatment plants, etc. One of the simplest and the mostly spread flow sheets for biogas production and utilization is shown in Figure 2 [7].
Illustration of biogas cycle, formation, and applications. Scheme taken from [7].
The main fuel in the scheme, shown in Figure 2, is biogas, utilized for energy (thermal one and electricity) or fuel for transport. The carbon dioxide released after combustion is absorbed by the vegetation by photosynthesis, thus closing the carbon cycle. The residual sludge from the digester is rich of organic nitrogen, and therefore, it is suitable for fertilizing the soil.
In the past, biogas has been widely spread as an energy source in the households in the countries of Africa and Asia. Although quite primitive as design, the anaerobic digesters have solved the problems with autonomous energy supply for many households in India, Pakistan, Indo-China, etc.
Later, biogas became very important and essential share as energy source for the countries in Western Europe and Northern America. Besides heating, biogas is now more frequently used for the production of electricity and transport fuel in many municipalities. It is already added to the pipelines for natural gas distribution of household purposes.
A new trend in biogas production and utilization is the so-called biorefinery concept. This concept not only presumes the use of renewable biomass as energy source but also combines it with the production of chemicals, such as plastics, solvents, and synthetic fuels [8]. An example for this is the Danish Bioethanol Concept presented by Zafar [9]. It comprises the ethanol production from lignocellulosic biomass with biogas production of the stillage and cellulose waste. The residual cellulose waste is additionally recycled after wet-oxidation for additional conversion into biogas. A detailed review on biogas applications is published recently by Sawyerr et al. [10].
The variety of anaerobic digesters for biogas production is very broad: from the very primitive pits to most sophisticated bioreactors, such as the floating drum reactor, the upflow anaerobic sludge blanket (UASB) reactor [11, 12, 13], and multistage bioreactor with separated compartments [14, 15]. The choice for anaerobic digester depends on the origin of substrate, and the intermediates are converted during the consecutive steps of hydrolysis, acidification, acetogenesis, and final methanation. In case an accumulation of fatty acids takes place, the reactor with separated compartments is preferable. The most exploited digester for biogas production from domestic waste, activated sludge, and manure is the UASB reactor.
The mostly used substrates for biogas production are the manure from cattle, pigs, and poultry litter. This application competes with the traditional use of manure for soil fertilization. When the amounts of manure prevail the demand for fertilization, biogas production is welcome because double problem is solved: on the one hand, the waste is destroyed and removed, and on the other hand, renewable energy is produced saving money and contributing for carbon cycle closing. That is why attention is paid to the utilization of cattle dung, lignocellulose waste, waste from food and beverage processing, activated sludge from wastewater treatment plants, and household solid waste with landfill gas use. The waste treatment is associated with energy production and reduction of the energy demand of the main enterprise.
Crude glycerol is the main residue from biodiesel production. The amount of this waste product is about 10% from the produced fuel. The poor quality of this glycerol, containing water, potassium hydroxide, and some methanol makes it non-suitable for market purposes even after purification. One alternative utilization of this residual glycerol is in its direct conversion into biogas, thus supplying the biodiesel plant with energy simultaneously. However, as a very simple and digestible substrate, glycerol yields large amounts of organic acids as intermediates, leading to strong inhibition of methanogenic bacteria [16, 17, 18]. That is why glycerol must be used as substrate for biogas production very cautiously with the addition of small amounts, thus making this process with little practical use. It is reported, however, that small additions of glycerol to other basic substrates, i.e. manure, can boost biogas production, as reported by Robra et al. [19] and Astals et al. [20].
Food industry is also a good source for biogas production.
Traditional biogas contains approximately 60% (vol.) methane, almost 40% carbon dioxide, small amounts of ethane and hydrogen (less than 0.5% together), hydrogen sulfide and mercaptanes (some ppm), humidity, and traces of oxygen. Its net energy capacity is ca. 24 MJ/nm3 at methane content of 60% (vol.). The first and most direct use of biogas is for heating purposes for maintenance of the equipment and the farm, where the animal dung is treated. The same applies for its use for domestic purposes, besides heating, e.g., cooking and lighting, as firstly used in Asian and African countries.
Another more sophisticated use of the biogas heating capacity is its utilization as heat energy in beverage and ethanol production. There the stillage remaining after distillation is recycled for biogas production. The resulting biogas is combusted for boiler heating and for energy for operation of distillation columns. Thus, the problems with the treatment of the residual stillage are solved by conversion into biogas, thus mitigating the problems with energy supply and spending. Calculations show that in some cases, stillage utilization as biogas can cover almost the whole energy demand for heating the distillation process. Besides these straightforward applications, biogas is also injected into the grid for natural gas supply for domestic use [21, 22]. For this purpose, a preliminary scrubbing of the carbon dioxide and sulfur compounds is necessary.
Biogas is suitable for generation of electric power in combination with heat recovery. Usually the gas is combusted in engines with internal combustion coupled to turbine. The released heat (being around 60% of the utilized energy) is used for heating purposes for maintenance of the anaerobic digester or for household needs. This method is widely applied for the treatment of activated sludge, a residue from municipal wastewater treatment plants [23, 24].
Electricity production by gas turbines can be applied by biogas as a fuel, thus replacing the natural gas for small-scale applications (or power within 25–100 kW).
The use of biogas as a fuel for civil transport and road vehicles instead of natural gas is already spread in Western Europe and the United States [25]. There are many vehicles in Sweden operating on biogas in the urban public transport [26].
Another very attractive application of biogas for electricity production is its use in fuel cells. The specialized cells for these purposes are described briefly by O’Hayre et al. [27]. Prior to biogas feed, carbon dioxide and sulfur compounds must be removed by scrubbing to avoid corrosion and catalyst poisoning and to rise the gas energy capacity. A sketch of such a fuel cell is shown in Figure 3, cf. [28].
Principal sketch of methane-driven fuel cell, from [28].
The classic process for methane-driven fuel cells is to convert catalytically by steam reforming methane into a mixture of carbon monoxide and hydrogen and to use the latter in a traditional hydrogen/oxygen fuel cell to generate electricity. The advantages of fuel cell applications with methane as a fuel compared to the traditional heat power stations consist in their higher efficiency, clean waste gases (containing almost only carbon dioxide), and higher efficiency at low loads than the gas turbine equipment [29]. Moreover, the released heat can be utilized for different purposes; the main one is to maintain the temperature regime in the fuel cell. There are many practical applications of these methods. It is already widely commercialized. A disadvantage of this method is the necessity of consequent reactions of steam reforming and carbon monoxide removal as well as the operation at high temperatures (about 750°C), being harmful for the metal parts of the equipment [30, 31]. Higher temperatures are preferred to avoid coke deposition on the catalyst [31].
There are new efforts to lower the operation temperature to 500°C in order to keep the equipment durability [32, 33]. Another improvement of the technology is to use the mixture of carbon monoxide and hydrogen as a fuel simultaneously, thus simplifying the whole process, but applying new catalytic process.
The most attractive option is to convert methane (biogas, respectively) into electricity in one step, thus avoiding the steam reforming and carbon dioxide removal. There are some new studies showing direct catalytic oxidation of methane in the anodic space of solid oxide fuel cells (SOFCs), with direct activation of the C-H bonds in the methane molecule [28, 34, 35, 36]. A platinum catalyst was used for this purpose at low temperatures, e.g., 80°C. However, the catalyst deactivates, and the process is limited by methane diffusion in the anodic space. As a result, the power density is still low for practical use.
Besides as a fuel, biogas could be used as a feedstock for synthetic organic fuel production. There are studies claiming for biogas recovery as fuels applying catalytic auto-reforming. Another approach is the dry reforming consisting in converting the equimolar mixture of methane and carbon dioxide into synthesis gas (an equimolar mixture of carbon monoxide and hydrogen).
Afterward, this synthesis gas is converted into a mixture of light hydrocarbons by the catalytic Fischer-Tropsch process. The resulting Fischer-Tropsch process yields liquid hydrocarbon fuels (methanol and dimethyl ether). The intrinsically high-energy density of these fuels and their transportability make them highly desirable. Such synthetic fuels do not contain any sulfur. In addition, methanol (arguably the “simplest” synthetic carbonaceous fuel) is a candidate both as a hydrogen source for a fuel cell vehicle and indeed as a transport fuel, and dimethyl ether is viewed as a “superclean” diesel fuel [36]. It is well known that methanol is a starting material in chemical industry. It is a liquid at room temperature and has much easier storage and transport capabilities than alternatives such as methane and hydrogen. Methanol is used as solvent, gasoline additive, and a chemical feedstock for production of biodiesel and other chemicals of high value. Therefore, the wide application of methanol motivates its large-scale production, which is ever increasing.
However, presently, the dominant technology of methanol is a two-step catalytic process, which is too expensive. A large number of industrial-scale chemical manufacturing processes are currently operated worldwide on the basis of strongly endothermic chemical reactions. The steam reforming of hydrocarbons to yield syngas and hydrogen is a classic example:
The above, highly endothermic reaction is used worldwide for the high-volume production of “merchant hydrogen” in the gas, food, and fertilizer industries, i.e., other portions of energy have to be spent with the consequent air pollution by carbon dioxide.
At present, a relevant technology for methanol production resides in the transformation of CO2 and CH4 to molecules having industrial added values. Among such technologies, a great attention is focused on the production of synthesis gas (gaseous mixture of CO and H2) that constitutes a versatile building block for subsequent production of methanol or chemical intermediates in petrochemical industries. Methanol is still produced on a world scale from synthesis gas, which is combination of varying amounts of H2, CO, and CO2 (at 200–300°C, 50–100 bar), which is itself product of steam reforming of methane (SRM; at ca. 800°C over Ni-based catalyst), followed by further conversion processes such as Fischer-Tropsch (FT) synthesis. This two-step process incurs high energy and capital demands. Additionally, this process gives many other light and heavy weight co-products along with the methanol product. Therefore, additional energy and cost in the conventional methanol plants are directed to the separation of these coproducts from methanol prior to the final deposition of product.
The direct synthesis of methanol from syngas requires a H2/CO ratio of about 2 [37, 38]. Since the syngas produced by dry reforming of methane (DRM) is too poor of H2 (H2/CO ≤ 1) to be fed to a FT synthesis unit, the bi-reforming of methane (BRM), combining DRM with steam reforming of methane (SRM) (H2/CO = 3) and the utilization of the most important two greenhouse gases CH4 and CO2 with water, may yield a syngas with ratio close to 2, the so-called “metgas”:
To date, only one plant with the combination of steam and dry reforming has been recently demonstrated by the Japan Oil, Gas, and Metals National Cooperation. No other industrial technology for DRM has been developed because the selection and design of suitable reforming catalyst remain an important challenge. Ni-based catalysts are the most attractive candidates for large-scale industrial applications due to their high activity in DRM and SRM [39, 40, 41, 42, 43], low cost, and wide availability compared to noble metals. However, they are sensitive to deactivation caused by the metal particles sintering and carbon formation at high reaction temperature of reforming processes. Development of selective and coke-resistance modified Ni-based reforming catalysts is a key challenge for successful application of bi-reforming for methanol production. Modifying Ni catalysts with suitable promoters and supported on reducible metal oxide carriers will give the opportunity to develop active and stable catalysts for bi-reforming of methane.
A “super-dry” CH4 reforming reaction for enhanced CO production from CH4 and CO2 was developed [44]. Ni/MgAl2O4 was used as a CH4 reforming catalyst, Fe2O3/MgAl2O4 was used as a solid oxygen carrier, and CaO/Al2O3 was used as a CO2 sorbent. The isothermal coupling of these three different processes resulted in a higher CO production than conventional dry reforming by avoiding back reactions with water. Equation (3) shows the global reaction of this two-step process, in which CO and H2O are inherently separated because of the two-step process configuration:
It is important to note that despite the apparently higher endothermic effect of the super-dry reforming process than conventional DRM (Eq. 1), the required heat input per mole CO2 converted is much lower (110 kJ/mol CO2 compared to 247 kJ/mol CO2). Finally, given the availability of a renewable source of H2, applications are possible where CO and H2 can be combined in different ratios for the formation of chemicals or fuels [45, 46]. Indeed, an efficient and separate production of high purity CO and H2 would further establish the role of syngas as a versatile and flexible platform mixture.
All these methods and techniques are applicable when biogas is available. Some other applications are described briefly below.
First of all, biogas must be purified for sulfur compounds prior to its use [47]. Afterward, methane and carbon dioxide have to be separated by membrane processes using gas-liquid systems [48] or swing pressure adsorption [49]. Once methane and carbon dioxide are separated, each of them has its own route for further application. Besides the already mentioned applications as a fuel for transport and energy purposes, dry reforming and steam reforming to obtain synthesis gas, the purified methane can be converted into light hydrocarbons, e.g., ethane and ethylene by advanced methods, like the so-called VYJ process [50, 51, 52, 53]. By this method, methane is converted in one step into ethylene by catalytic or electrocatalytic reaction [54, 55, 56].
High yields up to 88% in total are attained [50]. The rest of nonreacted methane is trapped in molecular sieves and recycled to the reactor [50, 53, 54]. In this way, the use of methane reaches 97% with an ethylene yield of 85% [50].
As ethylene is a basic feedstock for the mostly spread polymerizations and many value-added chemicals, it is clear that this way of biogas utilization is quite promising one.
The usual criteria for the feasibility of an anaerobic digestion technology are the type of digester, the operation temperature, the necessary retention time of the substrate in the reactor, the substrate acidity (the initial pH value), and the presence of certain chemicals in the inlet slurry.
However, the most important one is energy demand for the biogas formation and the energy potential of the produced biogas.
There are two typical temperature ranges for biogas production: mesophilic one (at 30–35°C) and thermophilic one (at 55–60°C). Different genera of methanogenic microorganisms are capable to accomplish the processes in those two cases. The advantages of the thermophilic regime are in the higher production rate and the lack of pathogens in the outlet slurry. However, the energy input for maintenance of this regime is higher than for the mesophilic one.
The question of the energy demand for any industrial process is of crucial importance for its economic reliability. The same applies to biogas production.
There are some methodologies for the estimation of the feasibility of biogas production [57, 58]. They all involve the demand of heat for temperature maintenance and electricity for mechanical operations (stirring, pumping, and transport) and comparison to the energy yield after anaerobic digestion.
Generally, the operations for a certain flowsheet are separated into production processes and support ones. The production processes in the considered case are the reception of the substrate and its storage, pre-treatment of feed (dilution, pH adjustment, acid hydrolysis, etc.), and anaerobic digestion with biogas production. The removal of the digestate and its storage and processing are also included. This set of processes is called as Level 1 [57].
Once biogas is produced, it could be used for direct heat and/or electricity production and supplied to customers or for own use (Level 2). More sophisticated operations, such as gas cleaning, upgrading (i.e., removal of carbon dioxide), and compressing the upgraded gas, are required if the gas will be distributed by the gas distribution grid or for some chemical applications.
The methodologies for energy demand evaluation consist in the inventory of all such processes and auxiliary ones with their energy demand per unit production (i.e., amount of produced biogas with certain energy potential). Then, the overall energy demand is compared to the biogas yield with its energy potential, and the percentage of the energy input to the overall yield is a measure for feasibility of the studied technology.
The structures of the energy demand for different flow sheets and the weight of different subprocesses depend on the substrate properties (particles size, chemical structure and content, moisture, and total solid content) and the amount to be treated, the digester construction and design.
Berglund and Borjesson [58] proposed a methodology based on the life-cycle perspective including the energy required for the production of the substrates (including crop growth, harvesting, transport, etc.). The energy efficiency is defined by the ratio of the energy input to the energy yield of the produced biogas. It was found that the energy input corresponds mainly to 15–40% of the energy content of the produced biogas. The subprocesses of extensive handling of raw materials may lead to considerably increase the energy input and thus to undermine the feasibility of the entire technology.
In case the gas will be used as a feedstock for other chemical applications (e.g., dry reforming and steam reforming), the operational costs of the processes at Levels 1 and 2 have to be compared to the operational costs for the chemical processes and the prices of the produced chemicals or other final products.
The main disadvantage of biomass produced fuels is the inevitable release of CO2 in the atmosphere after combustion. Therefore, big efforts are made in the recent years for remediation of this adverse effect of greenhouse gas. The best way to cope with this problem is the natural assimilation by the vegetation by photosynthesis, but it is not sufficient due to the very large emissions from industrial sources, energy production, transport, and household. That is why many other methods are proposed and studied in the recent years.
One of them is the direct use of pure carbon dioxide as a solvent in supercritical extraction in the pharmaceutical industry. However, this application is limited and cannot be a substantial solution of the problem. There are many efforts to recycle carbon dioxide to produce different organic chemicals: formic acid, methanol, dimethyl-ether, poly-carbonates, acrylic acid, etc. [59, 60]. All of these methods are applicable for the residual carbon dioxide after separation from biogas. Therefore, not only methane but also carbon dioxide in biogas is valuable source of energy and value-added product.
The data presented here illustrate one of the very important biorefinery approaches to produce simultaneous energy and value-added chemicals from biomass, thus reducing the demand of fossil fuels and resulting in overloading of atmosphere by greenhouse gases. The same applies to the water and soil pollution, since those resulting from biomass processing are nature compatible and facilitate the formation of close energy and material cycle. One of the ways to do it is biogas production from such waste.
At the end, we can say that biogas extends its area of application leading simultaneously to protect the environment by waste treatment, natural gas, and fossil fuel saving, as well as to replace, at least partially, the oil as a feedstock for organic value-added products.
This work was supported by the Bulgarian Ministry of Education and Science under the National Research Program Eplus: Low Carbon Energy for the Transport and Households, grant agreement D01-214/2018.
The authors declare no conflict of interest.
Authors are listed below with their open access chapters linked via author name:
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\\n\\nMohamed Oukka 2016-18
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\\n\\nFei Wei 2016-18
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\n\n\n\n\n\n\n\n\n\nJocelyn Chanussot (chapter to be published soon...)
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\n\nAbdul Latif Ahmad 2016-18
\n\nKhalil Amine 2017, 2018
\n\nEwan Birney 2015-18
\n\nFrede Blaabjerg 2015-18
\n\nGang Chen 2016-18
\n\nJunhong Chen 2017, 2018
\n\nZhigang Chen 2016, 2018
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\n\nFei Wei 2016-18
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USA, CRC Press Taylor & Francis, Asia Pacific, Trans Tech Publications Ltd., Switzerland, and Materials Science Forum, USA. He is a member of various editorial boards serving as associate editor for journals such as Environmental Chemistry Letter, Applied Water Science, Euro-Mediterranean Journal for Environmental Integration, Springer-Nature, Scientific Reports-Nature, and the editor of Eurasian Journal of Analytical Chemistry.",institutionString:"King Abdulaziz University",institution:{name:"King Abdulaziz University",country:{name:"Saudi Arabia"}}},{id:"99002",title:"Dr.",name:null,middleName:null,surname:"Koontongkaew",slug:"koontongkaew",fullName:"Koontongkaew",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Thammasat University",country:{name:"Thailand"}}},{id:"156647",title:"Dr.",name:"A K M Mamunur",middleName:null,surname:"Rashid",slug:"a-k-m-mamunur-rashid",fullName:"A K M Mamunur Rashid",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:"MBBS, DCH, MD(Paed.), Grad. Cert. P. Rheum.(UWA, Australia), FRCP(Edin.)",institutionString:null,institution:{name:"Khulna Medical College",country:{name:"Bangladesh"}}},{id:"234696",title:"Prof.",name:"A K M Mominul",middleName:null,surname:"Islam",slug:"a-k-m-mominul-islam",fullName:"A K M Mominul Islam",position:null,profilePictureURL:"https://intech-files.s3.amazonaws.com/a043Y00000cA8dpQAC/Co2_Profile_Picture-1588761796759",biography:"Prof. Dr. A. K. M. Mominul Islam received both of his bachelor's and Master’s degree from Bangladesh Agricultural University. After that, he joined as Lecturer of Agronomy at Bangladesh Agricultural University (BAU), Mymensingh, Bangladesh, and became Professor in the same department of the university. Dr. Islam did his second Master’s in Physical Land Resources from Ghent University, Belgium. He is currently serving as a postdoctoral researcher at the Department of Horticulture & Landscape Architecture at Purdue University, USA. Dr. Islam has obtained his Ph.D. degree in Plant Allelopathy from The United Graduate School of Agricultural Sciences, Ehime University, Japan. The dissertation title of Dr. Islam was “Allelopathy of five Lamiaceae medicinal plant species”. Dr. Islam is the author of 38 articles published in nationally and internationally reputed journals, 1 book chapter, and 3 books. He is a member of the editorial board and referee of several national and international journals. He is supervising the research of MS and Ph.D. students in areas of Agronomy. 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Omar obtained\nhis Bachelor degree in electrical and\nelectronics engineering from Universiti\nSains Malaysia in 2002, Master of Science in electronics\nengineering from Open University\nMalaysia in 2008 and PhD in optical physics from Universiti\nSains Malaysia in 2012. His research mainly\nfocuses on the development of optical\nand electronics systems for spectroscopy\napplication in environmental monitoring,\nagriculture and dermatology. He has\nmore than 10 years of teaching\nexperience in subjects related to\nelectronics, mathematics and applied optics for\nuniversity students and industrial engineers.",institutionString:null,institution:{name:"Universiti Sains Malaysia",country:{name:"Malaysia"}}},{id:"191072",title:"Prof.",name:"A. K. M. Aminul",middleName:null,surname:"Islam",slug:"a.-k.-m.-aminul-islam",fullName:"A. K. M. Aminul Islam",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/191072/images/system/191072.jpg",biography:"Prof. Dr. A. K. M. Aminul Islam received both of his bachelor and Master’s degree from Bangladesh Agricultural University. After that he joined as Lecturer of Genetics and Plant Breeding at Bangabandhu Sheikh Mujibur Rahman Agricultural University (BSMRAU), Gazipur, Bangladesh and became Professor in the same department of the university. He is currently serving as Director (Research) of Bangabandhu Sheikh Mujibur Rahman Agricultural University (BSMRAU), Gazipur, Bangladesh. Dr. Islam has obtained his Ph D degree in Chemical and Process Engineering from Universiti Kebangsaan Malaysia. The dissertation title of Dr. Islam was “Improvement of Biodiesel Production through Genetic Studies of Jatropha (Jatropha curcas L.)”. Dr. Islam is the author of 98 articles published in nationally and internationally reputed journals, 11 book chapters and 3 books. He is a member of editorial board and referee of several national and international journals. 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