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| 1 | Use of portal pressure studies in the management of variceal haemorrhage显示文摘Portal hypertension occurs as a complication of liver cirrhosis and complications such as variceal bleeding lead to significant demands on resources. Endoscopy is the gold standard method for screening cirrhotic patients however universal endoscopic screening may mean a lot of unnecessary procedures as the presence of oesophageal varices is variable hence a large time and cost burden on endoscopy units to carry out both screening and subsequent follow up of variceal bleeds. A less invasive method to identify those at high risk of bleeding would allow earlier prophylactic measures to be applied. Hepatic venous pressure gradient (HVPG) is an acceptable indirect measurement of portal hypertension and predictor of the complications of portal hypertension in adult cirrhotics. Varices develop at a HVPG of 10-12 mmHg with the appearance of other complications with HPVG > 12 mmHg. Variceal bleeding does not occur in pressures under 12 mmHg. HPVG > 20 mmHg measured early after admission is a significant prognostic indicator of failure to control bleeding varices, indeed early transjugular intrahepatic portosystemic shunt (TIPS) in such circumstances reduces mortality significantly. HVPG can be used to identify responders to medical therapy. Patients who do not achieve the suggested reduction targets in HVPG have a high risk of rebleeding despite endoscopic ligation and may not derive significant overall mortality benefit from endoscopic intervention alone, ultimately requiring TIPS or liver transplantation. Early HVPG measurements following a variceal bleed can help to identify those at risk of treatment failure who may benefit from early intervention with TIPS. Therefore, we suggest using HVPG measurement as the investigation of choice in those with confirmed cirrhosis in place of endoscopy for intitial variceal screening and, where indicated, a trial of B-blockade, either intravenously during the initial pressure study with assessment of response or oral therapy with repeat HVPG six weeks later. In those with elevated pressures, primary medical prophylaxis could be commenced with subsequent close monitoring of HVPG thus negating the need for endoscopy at this point. All patients presenting with variceal haemorrhage should undergo HVPG measurement and those with a gradient greater than 20 mmHg should be considered for early TIPS. By introducing portal pressure studies into a management algorithm for variceal bleeding, the number of endoscopies required for further intervention and follow up can be reduced leading to significant savings in terms of cost and demand on resources. | Jennifer Addley Tony CK Tham William Jonathan Cash | 2012 | World Journal of Gastrointestinal Endoscopy2012，4，7： | 37 |
| 2 | Endoscopic placement of enteral feeding tubes显示文摘Malnutrition is common in patients with acute and chronic illness.Nutritional management of these malnourished patients is an essential part of healthcare.Enteral feeding is one component of nutritional support.It is the preferred method of nutritional support in patients that are not receiving adequate oral nutrition and have a functioning gastrointestinal tract(GIT).This method of nutritional support has undergone progression over recent times.The method of placement of enteral feeding tubes has evolved due to development of new feeding tubes and endoscopic technology.Enteral feeding can be divided into methods that provide short-term and long-term access to the GIT.This review article focuses on the current range of methods of gaining access to the GIT to provide enteral feed. | Gerard P Rafferty Tony CK Tham | 2010 | World Journal of Gastrointestinal Endoscopy2010，2，5： | 7 |
| 3 | Enteroscopy in small bowel Crohn's disease: A review显示文摘Crohn's disease(CD) is a chronic inflammatory condition of the gastrointestinal tract resulting in inflammation, stricturing and fistulae secondary to transmural inflammation. Diagnosis relies on clinical history, abnormal laboratory parameters, characteristic radiologic and endoscopic changes within the gastrointestinal tract and most importantly a supportive histology. The article is intended mainly for the general gastroenterologist and for other interested physicians. Management of small bowel CD has been suboptimal and limited due to the inaccessibility of the small bowel.Enteroscopy has had a significant renaissance recently, thereby extending the reach of the endoscopist,aiding diagnosis and enabling therapeutic interventions in the small bowel. Radiologic imaging is used as the first line modality to visualise the small bowel. If the clinical suspicion is high, wireless capsule endoscopy(WCE) is used to rule out superficial and early disease, despite the above investigations being normal. This is followed by push enteroscopy or device assisted enteroscopy(DAE) as is appropriate. This approach has been found to be the most cost effective and least invasive. DAE includes balloon-assisted enteroscopy, [double balloon enteroscopy(DBE), single balloon enteroscopy(SBE) and more recently spiral enteroscopy(SE)]. This review is not going to cover the various other indications of enteroscopy, radiological small bowel investigations nor WCE and limited only to enteroscopy in small bowel Crohn's. These excluded topics already have comprehensive reviews.Evidence available from randomized controlled trials comparing the various modalities is limited and at best regarded as Grade C or D(based on expert opinion).The evidence suggests that all three DAE modalities have comparable insertion depths, diagnostic and therapeutic efficacies and complication rates, though most favour DBE due to higher rates of total enteroscopy. SE is quicker than DBE, but lower complete enteroscopy rates. SBE has quicker procedural times and is evolving but the least available DAE today. Larger prospective randomised controlled trial's in the future could help us understand some unanswered areas including the role of BAE in small bowel screening and comparative studies between the main types of enteroscopy in small bowel CD. | Benjamin Tharian Grant Caddy Tony CK Tham | 2013 | World Journal of Gastrointestinal Endoscopy2013，5，10： | 1 |
| 4 | Risk fac- tors for complications after performance of ERCP 显示文摘 | Jo Vandervoort Roy MS Tony CK Tham | 2002 | Gastro- intestinal Endoscopy2002，56，： | 1 |
| 5 | 最大限度地减小在汽车环境中的EMI显示文摘印刷电路板布局决定着所有电源的成败,决定着功能、电磁干扰(EMI)和受热时的表现。开关电源布局不是魔术,并不难,只不过在最初设计阶段,可能常常被忽视。然而,因为功能和EMI要求都要必须满足,所以对电源功能稳定性有益的安排也常常有利于降低EMI辐射, | Tony Armstrong Christian Kück | 2014 | 今日电子2014，，1： | 0 |
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