Chapters authored
Oral Tacrolimus in Patients with Ulcerative Colitis
Tacrolimus is a macrolide immunosuppressant that is structurally similar to rapamycin and has been found to have potent immunosuppressive properties, showing 10- to 100-fold higher potency for inhibiting lymphocyte activation than cyclosporine A (CsA). Because less variability in absorption and serum levels is observed among patients treated with tacrolimus compared with those who receive oral CsA, tacrolimus has been suggested to be more easily and safely administered to patients with refractory ulcerative colitis (UC) than CsA. However, because oral tacrolimus has a slower onset of action than intravenous CsA and food intake is known to reduce tacrolimus serum trough levels due to its low absorption rate, the proper method for administration of oral tacrolimus has not been determined. Moreover, the long-term effects of oral tacrolimus also remain unclear. In this chapter, key issues regarding the use of oral tacrolimus in patients with UC are reviewed.
Part of the book: New Insights into Inflammatory Bowel Disease
EUS-Guided Biliary Drainage
Endoscopic ultrasound-guided biliary drainage (EUS-BD) has been developed as an alternative method for failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-BD can be divided into two main approach routes, such as transgastric or transduodenal approach. Also, EUS-guided hepaticogastrostomy, choledochoduodenostomy (CDS), and gallbladder drainage (GBD) have been reported. In this chapter, we described technical tips for each basic technique, including literature review. As advanced technique of EUS-BD, antegrade stone removal has been reported. More recently, electrohydraulic lithotripsy for bile duct stones under transluminal cholangioscopy guidance, hepaticojejunostomy stricture dilation through EUS-hepaticogastrostomy (HGS) route, or EUS-guided gastrojejunostomy has been reported. Although EUS-BD has various potential as treatment technique, treatment method should be selected for each patient’s conditions.
Part of the book: Advanced Endoscopy