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Likhtshteyn M, Marzouk E, Arroyo-Mercado FM, Chawla G, Rosengarten S, Lerer R, Ojeda-Martinez H, Thor S. Human immunodeficiency virus patients with low CD4 counts are more likely to have precancerous polyps identified during index colonoscopy. World J Gastrointest Endosc 2023; 15:545-552. [DOI: 10.4253/wjge.v15.i9.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/16/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023] [Imported: 09/13/2023] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) has improved the life expectancy of patients living with human immunodeficiency virus (HIV). As these patients age, they are at increased risk for developing non-acquired immunodeficiency syndrome defining malignancies (NADMs) such as colon cancers.
AIM To determine which factors are associated with the development of precancerous polyps on screening colonoscopy in patients with HIV and to investigate whether HIV disease status, measured by viral load and CD4 count, might influence precancerous polyp development.
METHODS A retrospective review of records at two urban academic medical centers was performed for HIV patients who had a screening colonoscopy between 2005-2015. Patients with a history of colorectal cancer or polyps, poor bowel preparation, or inflammatory bowel disease were excluded. Demographic data such as sex, age, race, and body mass index (BMI) as well as information regarding the HIV disease status such as CD4 count, viral load, and medication regimen were collected. Well-controlled patients were defined as those that had viral load < 50 copies, and poorly-controlled patients were those with viral load ≥ 50. Patients were also stratified based on their CD4 count, comparing those with a low CD4 count to those with a high CD4 count. Using colonoscopy reports in the medical record, the size, histology, and number of polyps were recorded for each patient. Precancerous polyps included adenomas and proximal serrated polyps. Data was analyzed using Fisher’s exact tests and logistic regression through SAS 3.8 software.
RESULTS Two hundred and seven patients met our inclusion criteria. The mean age was 56.13 years, and 58% were males. There were no significant differences in terms of age, race or ethnicity, insurance, and smoking status between patients with CD4 counts above or below 500. BMI was lower in patients with CD4 count < 500 as compared to those with count > 500 (P = 0.0276). In patients with CD4 > 500, 53.85% of patients were female, and 70.87% of patients with CD4 < 500 were male (P = 0.0004). Only 1.92% of patients with CD4 ≥ 500 had precancerous polyps vs 10.68% of patients with CD4 < 500 (P = 0.0102). When controlled for sex, BMI, and ART use, patients with CD4 < 500 were 9.01 times more likely to have precancerous polyps [95% confidence interval (CI): 1.69-47.97; P = 0.0100]. Patients taking non-nucleoside reverse transcriptase inhibitors were also found to be 10.23 times more likely to have precancerous polyps (95%CI: 1.08-97.15; P = 0.0428). There was not a significant difference noted in precancerous polyps between those that had viral loads greater or less than 50 copies.
CONCLUSION Patients with low CD4 counts were more likely to have precancerous polyps on their screening colonoscopy although the etiology for this association is unclear. We also found an increased risk of precancerous polyps in patients taking non-nucleoside reverse transcriptase inhibitors, which is contradictory to prior literature showing ART has decreased the risk of development of NADMs. However, there have not been studies looking at colorectal cancer and ART by drug class, to our knowledge. Further prospective studies are needed to determine the effect of HIV control and therapies on polyp development.
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Affiliation(s)
- Michelle Likhtshteyn
- Department of Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Evan Marzouk
- Department of Internal Medicine and Pediatrics, Baystate Medical Center, Springfield, IL 01199, United States
| | - Fray M Arroyo-Mercado
- Department of Gastroenterology, University of New Mexico, Albuquerque, NM 87106, United States
| | - Gurasees Chawla
- Department of Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Sabrina Rosengarten
- Department of Emergency Medicine, New York-Presbyterian Queens Hospital, Queens, NY 11355, United States
| | - Renata Lerer
- Department of Gastroenterology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Hector Ojeda-Martinez
- Department of Infectious Disease, Nuvance Health-Vassar Brothers Medical Center, Poughkeepsie, NY 12601, United States
| | - Savanna Thor
- Department of Gastroenterology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, United States
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Huang YF, Hu SJ, Bu Y, Li YL, Deng YH, Hu JP, Yang SQ, Shen Q, McAlindon M, Shi RC, Li XQ, Song TY, Qi HL, Jiao TW, Liu MY, He F, Zhu J, Ma B, Yu XB, Guo JY, Yu YH, Yong HJ, Yao WT, Ye T, Wang H, Dong WF, Liu JG, Wei Q, Tian J, Li XG, Dray X, Qi XL. Endoscopic Ruler for varix size measurement: A multicenter pilot study. World J Gastrointest Endosc 2023; 15:564-573. [DOI: 10.4253/wjge.v15.i9.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/18/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023] [Imported: 09/13/2023] Open
Abstract
BACKGROUND We invented Endoscopic Ruler, a new endoscopic device to measure the size of varices in patients with cirrhosis and portal hypertension.
AIM To assess the feasibility and safety of Endoscopic Ruler, and evaluate the agreement on identifying large oesophageal varices (OV) between Endoscopic Ruler and the endoscopists, as well as the interobserver agreement on diagnosing large OV using Endoscopic Ruler.
METHODS We prospectively and consecutively enrolled patients with cirrhosis from 11 hospitals, all of whom got esophagogastroduodenoscopy (EGD) with Endoscopic Ruler. The primary study outcome was a successful measurement of the size of varices using Endoscopic Ruler. The secondary outcomes included adverse events, operation time, the agreement of identifying large OV between the objective measurement of Endoscopic Ruler and the empirical reading of endoscopists, together with the interobserver agreement on diagnosing large OV by Endoscopic Ruler.
RESULTS From November 2020 to April 2022, a total of 120 eligible patients with cirrhosis were recruited and all of them underwent EGD examinations with Endoscopic Ruler successfully without any adverse event. The median operation time of Endoscopic Ruler was 3.00 min [interquartile range (IQR): 3.00 min]. The kappa value between Endoscopic Ruler and the endoscopists while detecting large OV was 0.52, demonstrating a moderate agreement. The kappa value for diagnosing large OV using Endoscopic Ruler among the six independent observers was 0.77, demonstrating a substantial agreement.
CONCLUSION The data demonstrates that Endoscopic Ruler is feasible and safe for measuring the size of varices in patients with cirrhosis and portal hypertension. Endoscopic Ruler is potential to promote the clinical practice of the two-grade classification system of OV.
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Affiliation(s)
- Yi-Fei Huang
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Sheng-Juan Hu
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Yang Bu
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Yi-Ling Li
- Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Yan-Hong Deng
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Jian-Ping Hu
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Shao-Qi Yang
- Department of Gastroenterology, Ningxia Medical University General Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Qian Shen
- Department of Gastroenterology, Yinchuan Second People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Mark McAlindon
- Academic Department of Gastroenterology and Hepatology, Sheffield Teaching Hospitals NHS Trust, AL 35660, Sheffield, United Kingdom
| | - Rui-Chun Shi
- Department of Gastroenterology, Wuzhong People's Hospital, Wuzhong 751100, Ningxia Hui Autonomous Region, China
| | - Xiao-Qin Li
- Department of Gastroenterology, The Fifth People's Hospital of Ningxia Hui Autonomous Region, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Tie-Ying Song
- Department of Second Gastroenterology, The Sixth People’s Hospital of Shenyang, Shenyang 110000, Liaoning Province, China
| | - Hai-Long Qi
- Department of Gastroenterology, Shizuishan Second People's Hospital, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Tai-Wei Jiao
- Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Meng-Yuan Liu
- Department of Gastroenterology, The First Affiliated Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
| | - Fang He
- Department of Gastroenterology, Ningxia Medical University General Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Jun Zhu
- Department of Gastroenterology, The Fifth People's Hospital of Ningxia Hui Autonomous Region, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Bin Ma
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Xiao-Bin Yu
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Jian-Yang Guo
- Department of Gastroenterology, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University Affiliated People's Hospital of Autonomous Region, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Yue-Hua Yu
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Hai-Jiang Yong
- Department of Gastroenterology, Wuzhong People's Hospital, Wuzhong 751100, Ningxia Hui Autonomous Region, China
| | - Wen-Tun Yao
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Ting Ye
- Department of Gastroenterology, Yinchuan First People's Hospital, Yinchuan 750000, Ningxia Hui Autonomous Region, China
| | - Hua Wang
- Department of Gastroenterology, The Fifth People's Hospital of Ningxia Hui Autonomous Region, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Wen-Fu Dong
- Department of Gastroenterology, The Fifth People's Hospital of Ningxia Hui Autonomous Region, Shizuishan 753000, Ningxia Hui Autonomous Region, China
| | - Jian-Guo Liu
- Department of Gastroenterology, Zhongwei People's Hospital, Zhongwei 755000, Ningxia Hui Autonomous Region, China
| | - Qiang Wei
- Department of Gastroenterology, Zhongwei People's Hospital, Zhongwei 755000, Ningxia Hui Autonomous Region, China
| | - Jing Tian
- Department of Gastroenterology, Zhongwei People's Hospital, Zhongwei 755000, Ningxia Hui Autonomous Region, China
| | - Xiao-Guo Li
- Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xavier Dray
- Department of Hepato-Gastroenterology, ETIS, ENSEA, CNRS, Sorbonne Université & APHP, Hôpital Saint Antoine, Université Paris-Seine, Université de Cergy-Pontoise, Paris 75012, Sélectionner, France
| | - Xiao-Long Qi
- Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing 210000, Jiangsu Province, China
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Grover D, Fatima I, Dharan M. Comparison of trans-gastric vs trans-enteric (trans-duodenal or trans-jejunal) endoscopic ultrasound guided gallbladder drainage using lumen apposing metal stents. World J Gastrointest Endosc 2023; 15:574-583. [DOI: 10.4253/wjge.v15.i9.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/25/2023] [Accepted: 08/23/2023] [Indexed: 09/13/2023] [Imported: 09/13/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound guided gallbladder drainage (EUS-GBD) is being increasingly used in practice (either as a bridge to cholecystectomy in high-risk patients or as destination therapy in non-surgical patients). Stents are used to create a conduit between the lumen of the gallbladder (GB) and the intestinal lumen through the gastric or enteric routes. Among the various types of stents used, cautery-enhanced lumen apposing metallic stents (LAMS) may be associated with fewer adverse events (AEs).
AIM To compare the clinical success, technical success, and rate of AEs between transgastric (TG) and trans-enteric [transduodenal (TD)/transjejunal (TJ)] approach to GB drainage. Further, we analyzed whether using cautery enhanced stents during EUS-GBD impacts the above parameters.
METHODS Study was registered in PROSPERO (CRD42022319019) and comprehensive literature review was conducted. Manuscripts were reviewed for the data collection: Rate of AEs, clinical success, and technical success. Random effects model was utilized for the analysis.
RESULTS No statistically significant difference in clinical and technical success between the TD/TJ and TG approaches (P > 0.05) were noted. There was no statistically significant difference in the rate of AEs when comparing two-arm studies only. However, when all studies were included in the analysis difference was almost significant favoring the TD/TJ approach. When comparing cautery-enhanced LAMS with non-cautery enhanced LAMS, a statistically significant difference in the rate of AEs was observed when all the studies were included, with the rate being higher in non-cautery enhanced stents (14.0% vs 37.8%; P < 0.01).
CONCLUSION As per our study results, TD/TJ approach appears to be associated with lower rate of adverse events and comparable efficacy when compared to the TG approach for the EUS-GBD. Additionally, use of cautery-enhanced LAMS for EUS-GBD is associated with a more favorable adverse event profile compared to cold LAMS. Though the approach chosen depends on several patient and physician factors, the above findings could help in deciding the ideal drainage route when both TG and TD/TJ approaches are feasible.
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Affiliation(s)
- Dheera Grover
- Department of Internal Medicine, University of Connecticut, Farmington, CT 06030, United States
| | - Ifrah Fatima
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, United States
| | - Murali Dharan
- Department of Gastroenterology and Hepatology, University of Connecticut Health Center, Farmington, CT 06030, United States
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van Tuyll van Serooskerken ES, Gallo G, Weusten BL, Westerhof J, Brosens LAA, Zwaveling S, Ruiterkamp J, Hulscher JBF, Arets HGM, Bittermann AJN, van der Zee DC, Tytgat SHAJ, Lindeboom MYA. Graft dilatation and Barrett’s esophagus in adults after gastric pull-up and jejunal interposition for long-gap esophageal atresia. World J Gastrointest Endosc 2023; 15:553-563. [DOI: 10.4253/wjge.v15.i9.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/15/2023] [Accepted: 07/25/2023] [Indexed: 09/13/2023] [Imported: 09/13/2023] Open
Abstract
BACKGROUND Esophageal replacement (ER) with gastric pull-up (GPU) or jejunal interposition (JI) used to be the standard treatment for long-gap esophageal atresia (LGEA). Changes of the ER grafts on a macro- and microscopic level however, are unknown.
AIM To evaluate long-term clinical symptoms and anatomical and mucosal changes in adolescents and adults after ER for LGEA.
METHODS A cohort study was conducted including all LGEA patients ≥ 16 years who had undergone GPU or JI between 1985-2003 at two tertiary referral centers in the Netherlands. Patients underwent clinical assessment, contrast study and endoscopy with biopsy. Data was collected prospectively. Group differences between JI and GPU patients, and associations between different outcome measures were assessed using the Fisher’s exact test for bivariate variables and the Mann-Whitney U-test for continuous variables. Differences with a P-value < 0.05 were considered statistically significant.
RESULTS Nine GPU patients and eleven JI patients were included. Median age at follow-up was 21.5 years and 24.4 years, respectively. Reflux was reported in six GPU patients (67%) vs four JI patients (36%) (P = 0.37). Dysphagia symptoms were reported in 64% of JI patients, compared to 22% of GPU patients (P = 0.09). Contrast studies showed dilatation of the jejunal graft in six patients (55%) and graft lengthening in four of these six patients. Endoscopy revealed columnar-lined esophagus in three GPU patients (33%) and intestinal metaplasia was histologically confirmed in two patients (22%). No association was found between reflux symptoms and macroscopic anomalies or intestinal metaplasia. Three GPU patients (33%) experienced severe feeding problems vs none in the JI group. The median body mass index of JI patients was 20.9 kg/m2vs 19.5 kg/m2 in GPU patients (P = 0.08).
CONCLUSION The majority of GPU patients had reflux and intestinal metaplasia in 22%. The majority of JI patients had dysphagia and a dilated graft. Follow-up after ER for LGEA is essential.
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Affiliation(s)
| | - Gabriele Gallo
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen 9713 GZ, Netherlands
| | - Bas L Weusten
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht 3508 AB, Netherlands
| | - Jessie Westerhof
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen 9713 GZ, Netherlands
| | - Lodewijk AA Brosens
- Department of Pathology, University Medical Center Utrecht, Utrecht 3508 AB, Netherlands
| | - Sander Zwaveling
- Department of Pediatric Surgery, Amsterdam University Medical Center, Amsterdam 1105 AZ, Netherlands
| | - Jetske Ruiterkamp
- Department of Pediatric Surgery, Wilhelmina Children’s Hospital, Utrecht 3508 AB, Netherlands
| | - Jan BF Hulscher
- Department of Pediatric Surgery, University Medical Center Groningen, Groningen 9713 GZ, Netherlands
| | - Hubertus GM Arets
- Department of Pediatric Pulmonology, Wilhelmina Children’s Hospital, Utrecht 3508 AB, Netherlands
| | - Arnold JN Bittermann
- Department of Pediatric Otorhinolaryngology, Wilhelmina Children’s Hospital, Utrecht 3508 AB, Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children’s Hospital, Utrecht 3508 AB, Netherlands
| | - Stefaan HAJ Tytgat
- Department of Pediatric Surgery, Wilhelmina Children’s Hospital, Utrecht 3508 AB, Netherlands
| | - Maud YA Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children’s Hospital, Utrecht 3508 AB, Netherlands
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George NM, Rajesh NA, Chitrambalam TG. Acute pancreatitis following endoscopic ampullary biopsy: A case report. World J Gastrointest Endosc 2023; 15:540-544. [PMID: 37663115 PMCID: PMC10473905 DOI: 10.4253/wjge.v15.i8.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/18/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023] [Imported: 08/10/2023] Open
Abstract
BACKGROUND Endoscopic biopsy is mandatory for the diagnosis of malignant and premalignant ampullary tumours. The commonly reported inadvertent complications following routine mucosal biopsy include perforation and haemorrhage. Acute pancreatitis is an extremely rare complication following this procedure. CASE SUMMARY This report details the case of a 59-year-old man who underwent biopsy of the ampulla for a suspected periampullary tumour. Following the procedure, the patient presented with symptoms of acute pancreatitis which was substantiated by laboratory and radiological investigations. He was conservatively managed and discharged following complete resolution of symptoms. CONCLUSION This case report serves to highlight the importance of this potential complication following routine endoscopic biopsy of the ampulla.
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Affiliation(s)
- Nidhi Mariam George
- Department of General Surgery, SRM Medical College Hospital and Research Centre, Chennai 603203, Tamil Nadu, India
| | - Nanda Amarnath Rajesh
- Department of Medical Gastroenterology, SRM Medical College Hospital and Research Centre, Chennai 6030203, India
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Gomes RSA, de Oliveira GHP, de Moura DTH, Kotinda APST, Matsubayashi CO, Hirsch BS, Veras MDO, Ribeiro Jordão Sasso JG, Trasolini RP, Bernardo WM, de Moura EGH. Endoscopic ultrasound artificial intelligence-assisted for prediction of gastrointestinal stromal tumors diagnosis: A systematic review and meta-analysis. World J Gastrointest Endosc 2023; 15:528-539. [PMID: 37663113 PMCID: PMC10473903 DOI: 10.4253/wjge.v15.i8.528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/15/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] [Imported: 08/10/2023] Open
Abstract
BACKGROUND Subepithelial lesions (SELs) are gastrointestinal tumors with heterogeneous malignant potential. Endoscopic ultrasonography (EUS) is the leading method for evaluation, but without histopathological analysis, precise differentiation of SEL risk is limited. Artificial intelligence (AI) is a promising aid for the diagnosis of gastrointestinal lesions in the absence of histopathology. AIM To determine the diagnostic accuracy of AI-assisted EUS in diagnosing SELs, especially lesions originating from the muscularis propria layer. METHODS Electronic databases including PubMed, EMBASE, and Cochrane Library were searched. Patients of any sex and > 18 years, with SELs assessed by EUS AI-assisted, with previous histopathological diagnosis, and presented sufficient data values which were extracted to construct a 2 × 2 table. The reference standard was histopathology. The primary outcome was the accuracy of AI for gastrointestinal stromal tumor (GIST). Secondary outcomes were AI-assisted EUS diagnosis for GIST vs gastrointestinal leiomyoma (GIL), the diagnostic performance of experienced endoscopists for GIST, and GIST vs GIL. Pooled sensitivity, specificity, positive, and negative predictive values were calculated. The corresponding summary receiver operating characteristic curve and post-test probability were also analyzed. RESULTS Eight retrospective studies with a total of 2355 patients and 44154 images were included in this meta-analysis. The AI-assisted EUS for GIST diagnosis showed a sensitivity of 92% [95% confidence interval (CI): 0.89-0.95; P < 0.01), specificity of 80% (95%CI: 0.75-0.85; P < 0.01), and area under the curve (AUC) of 0.949. For diagnosis of GIST vs GIL by AI-assisted EUS, specificity was 90% (95%CI: 0.88-0.95; P = 0.02) and AUC of 0.966. The experienced endoscopists' values were sensitivity of 72% (95%CI: 0.67-0.76; P < 0.01), specificity of 70% (95%CI: 0.64-0.76; P < 0.01), and AUC of 0.777 for GIST. Evaluating GIST vs GIL, the experts achieved a sensitivity of 73% (95%CI: 0.65-0.80; P < 0.01) and an AUC of 0.819. CONCLUSION AI-assisted EUS has high diagnostic accuracy for fourth-layer SELs, especially for GIST, demonstrating superiority compared to experienced endoscopists' and improving their diagnostic performance in the absence of invasive procedures.
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Affiliation(s)
- Rômulo Sérgio Araújo Gomes
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | | | - Diogo Turiani Hourneaux de Moura
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Ana Paula Samy Tanaka Kotinda
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Carolina Ogawa Matsubayashi
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Bruno Salomão Hirsch
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | - Matheus de Oliveira Veras
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
| | | | - Roberto Paolo Trasolini
- Division of Hepatology and Endoscopy, Department of Gastroenterology, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Wanderley Marques Bernardo
- Department of Gastroenterology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-010, Brazil
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Tan CQL, Loh GYW, Benjamin TWR, Koh CJ, Mok JSR, Hartono JL, Chua KTC, Tan HH, Siah KTH. Dental trauma in endoscopy: A systematic review and experience of a tertiary endoscopy centre. World J Gastrointest Endosc 2023; 15:518-527. [PMID: 37663114 PMCID: PMC10473904 DOI: 10.4253/wjge.v15.i8.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 07/06/2023] [Indexed: 08/10/2023] [Imported: 08/10/2023] Open
Abstract
BACKGROUND Dental injury is the leading cause of litigation in anaesthesia but an underrecognized preventable complication of endoscopy. AIM To determine frequency and effects of dental injury in endoscopy, we present findings from an audit of outpatient endoscopy procedures conducted at a tertiary university hospital and a systematic review of literature. METHODS Retrospective review of 11265 outpatient upper endoscopy procedures over the period of 1 June 2019 to 31 May 2021 identified dental related complications in 0.284% of procedures. Review of literature identified a similar rate of 0.33%. RESULTS Pre-existing dental pathology or the presence of prostheses makes damage more likely but sound teeth may be affected. Pre-endoscopic history and tooth examination are key for risk stratification and may be conducted succinctly with limited time outlay. Tooth retrieval should be prioritized in the event of dental injury to minimize aspiration and be followed by prompt dental consultation for specific management. CONCLUSION Dental complications occur in approximately 1 in 300 of upper endoscopy cases. These are easily preventable by pre-endoscopy screening. Protocols to mitigate dental injury are also suggested.
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Affiliation(s)
- Chelsea Qiu Lin Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117594, Singapore
| | - Gabrielle Yi Wen Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117594, Singapore
| | - Tay Wei Rong Benjamin
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | - Calvin Jianyi Koh
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | - John Shao Rong Mok
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | - Juanda Leo Hartono
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
| | | | - Hee Hon Tan
- Division of Prosthodontics, National University Centre for Oral Health, Singapore 119074, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, National University Health System, Singapore 119074, Singapore
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Wei MT, Friedland S. Strategies to manage the difficult colonoscopy. World J Gastrointest Endosc 2023; 15:491-495. [PMID: 37547242 PMCID: PMC10401407 DOI: 10.4253/wjge.v15.i7.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/22/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
During endoscopy, an endoscopist is inevitably faced with the occasional “difficult colonoscopy,” in which the endoscopist finds it challenging to advance the endoscope to the cecum. Beyond optimization of technique, with minimized looping, minimal insufflation, sufficient sedation, and abdominal splinting when needed, sometimes additional tools may be needed. In this review, we cover available techniques and technologies to help navigate the difficult colonoscopy, including the ultrathin colonoscope, rigidizing overtube, balloon-assisted colonoscopy and the abdominal compression device.
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Affiliation(s)
- Mike T Wei
- Department of Gastroenterology, Stanford University Medical Center, Palo Alto, CA 94306, United States
| | - Shai Friedland
- Department of Gastroenterology, Stanford University Medical Center, Palo Alto, CA 94306, United States
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9
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Iwamuro M, Hamada K, Kawano S, Kawahara Y, Otsuka M. Review of oral and pharyngolaryngeal benign lesions detected during esophagogastroduodenoscopy. World J Gastrointest Endosc 2023; 15:496-509. [PMID: 37547241 PMCID: PMC10401409 DOI: 10.4253/wjge.v15.i7.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 07/12/2023] Open
Abstract
Recent advancements in endoscopy equipment have facilitated endoscopists’ detection of neoplasms in the oral cavity and pharyngolaryngeal regions. In particular, image-enhanced endoscopy using narrow band imaging or blue laser imaging play an integral role in the endoscopic diagnosis of oral and pharyngolaryngeal cancers. Despite these advancements, limited studies have focused on benign lesions that can be observed during esophagogastroduodenoscopy in the oral and pharyngolaryngeal regions. Therefore, this mini-review aimed to provide essential information on such benign lesions, along with representative endoscopic images of dental caries, cleft palate, palatal torus, bifid uvula, compression by cervical osteophytes, tonsil hyperplasia, black hairy tongue, oral candidiasis, oral and pharyngolaryngeal ulcers, pharyngeal melanosis, oral tattoos associated with dental alloys, retention cysts, papilloma, radiation-induced changes, skin flaps, vocal cord paresis, and vocal fold leukoplakia. Whilst it is imperative to seek consultation from otolaryngologists or dentists in instances where the diagnosis cannot be definitively ascertained by endoscopists, the merits of attaining foundational expertise pertaining to oral and pharyngolaryngeal lesions are unequivocal. This article will be a valuable resource for endoscopists seeking to enhance their understanding of oral and pharyngolaryngeal lesions.
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Affiliation(s)
- Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Kenta Hamada
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Seiji Kawano
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Yoshiro Kawahara
- Department of Practical Gastrointestinal Endoscopy, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Motoyuki Otsuka
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan
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10
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Rio-Tinto R, Canena J, Devière J. Candy cane syndrome: A systematic review. World J Gastrointest Endosc 2023; 15:510-517. [PMID: 37547243 PMCID: PMC10401408 DOI: 10.4253/wjge.v15.i7.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Candy cane syndrome (CCS) is a condition that occurs following gastrectomy or gastric bypass. CCS remains underrecognized, yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery. No previous literature review on this subject has been published.
AIM To collate the current knowledge on CCS.
METHODS A literature search was conducted with PubMed and Google Scholar for studies from May 2007, until March 2023. The bibliographies of the retrieved articles were manually searched for additional relevant articles.
RESULTS Twenty-one articles were identified (135 patients). Abdominal pain, nausea/vomiting, and reflux were the most reported symptoms. Upper gastrointestinal (GI) series and endoscopy were performed for diagnosis. Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%. In surgical series, 9 complications were reported with no mortality. One study reported the surgical construction of a jejunal pouch with clinical success. Six studies described endoscopic approaches with 100% clinical success and no complications. In one case report, endoscopic dilation did not improve the patient’s symptoms.
CONCLUSION CCS remains underrecognized due to lack of knowledge about this condition. The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence. CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy. Diagnosis should be based on symptoms, endoscopy, and upper GI series. Blind loop resection is curative but complex and associated with significant complications. Endoscopic management using different approaches to divert flow is effective and should be further explored.
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Affiliation(s)
- Ricardo Rio-Tinto
- Digestive Oncology Unit, Champalimaud Foundation, Lisbon 1600, Lisbon, Portugal
| | - Jorge Canena
- Centro de Gastrenterologia, Hospital CUF Tejo - Nova Medical School/Faculdade de Ciências Médicas da UNL, Lisbon 1600, Lisbon, Portugal
- Serviço de Gastrenterologia, Hospital Amadora-Sintra, Amadora 1600, Lisbon, Portugal
- Serviço de Gastrenterologia, Hospital de Santo António dos Capuchos - CHLC, Lisbon 1600, Lisbon, Portugal
- Cintesis - Center for Health Technology and Services Research, Universidade do Minho, Braga 1600, Braga, Portugal
| | - Jacques Devière
- Digestive Oncology Unit, Champalimaud Foundation, Lisbon 1600, Lisbon, Portugal
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, Erasme Hospital - Université Libre de Bruxelles, Brussels 1050, Brussels, Belgium
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11
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Kahlon S, Aamar A, Butt Z, Urayama S. Role of endoscopic ultrasound for pre-intervention evaluation in early esophageal cancer. World J Gastrointest Endosc 2023; 15:447-457. [PMID: 37397975 PMCID: PMC10308272 DOI: 10.4253/wjge.v15.i6.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/08/2023] [Accepted: 05/12/2023] [Indexed: 06/14/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Endoscopic ultrasound (EUS) stands as an accurate imaging modality for esophageal cancer staging, however utilization of EUS in early-stage cancer management remains controversial. Identification of non-applicability of endoscopic interventions with deep muscular invasion with EUS in pre-intervention evaluation of early-stage esophageal cancer is compared to endoscopic and histologic indicators.
AIM To display the role of EUS in pre-intervention early esophageal cancer staging and how the index endoscopic features of invasive esophageal malignancy compare for prediction of depth of invasion and cancer management.
METHODS This was a retrospective study of patients who underwent pre-resection EUS after a diagnosis of esophageal cancer at a tertiary medical center from 2012 to 2022. Patient clinical data, initial esophagogastroduodenoscopy/biopsy, EUS, and final resection pathology reports were abstracted, and statistical analysis was conducted to assess the role of EUS in management decisions.
RESULTS Forty nine patients were identified for this study. EUS T stage was concordant with histological T stage in 75.5% of patients. In determining submucosal involvement (T1a vs T1b), EUS had a specificity of 85.0%, sensitivity of 53.9%, and accuracy of 72.7%. Endoscopic features of tumor size > 2 cm and the presence of esophageal ulceration were significantly associated with deep invasion of cancer on histology. EUS affected management from endoscopic mucosal resection/submucosal dissection to esophagectomy in 23.5% of patients without esophageal ulceration and 6.9% of patients with tumor size < 2 cm. In patients without both endoscopic findings, EUS identified deeper cancer and changed management in 4.8% (1/20) of cases.
CONCLUSION EUS was reasonably specific in ruling out submucosal invasion but had relatively poor sensitivity. Data validated endoscopic indicators suggested superficial cancers in the group with a tumor size < 2 cm and the lack of esophageal ulceration. In patients with these findings, EUS rarely identified a deep cancer that warranted a change in management.
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Affiliation(s)
- Sartajdeep Kahlon
- Department of Internal Medicine, University of California-Davis, Sacramento, CA 95817, United States
| | - Ali Aamar
- Department of Internal Medicine, University of California-Davis, Sacramento, CA 95817, United States
| | - Zeeshan Butt
- Department of Internal Medicine, Baystate Medical Center, Springfield, MA 01199, United States
| | - Shiro Urayama
- Department of Internal Medicine, University of California-Davis, Sacramento, CA 95817, United States
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12
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Maselli DB, Hoff AC, Kucera A, Weaver E, Sebring L, Gooch L, Walton K, Lee D, Cratty T, Beal S, Nanduri S, Rease K, Gainey CS, Eaton L, Coan B, McGowan CE. Endoscopic sleeve gastroplasty in class III obesity: Efficacy, safety, and durability outcomes in 404 consecutive patients. World J Gastrointest Endosc 2023; 15:469-479. [PMID: 37397974 PMCID: PMC10308273 DOI: 10.4253/wjge.v15.i6.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Endoscopic sleeve gastroplasty (ESG) is an effective therapy for class I-II obesity, but there are knowledge gaps in the published literature about its implementation in patients with class III obesity [body mass index (BMI) ≥ 40 kg/m2].
AIM To evaluate the safety, clinical efficacy, and durability of ESG in adults with class III obesity.
METHODS This was a retrospective cohort study that used prospectively collected data on adults with BMI ≥ 40 kg/m2 who underwent ESG and longitudinal lifestyle counseling at two centers with expertise in endobariatric therapies from May 2018-March 2022. The primary outcome was total body weight loss (TBWL) at 12 mo. Secondary outcomes included changes in TBWL, excess weight loss (EWL) and BMI at various time points up to 36 mo, clinical responder rates at 12 and 24 mo, and comorbidity improvement. Safety outcomes were reported through the study duration. One-way ANOVA test was performed with multiple Tukey pairwise comparisons for TBWL, EWL, and BMI over the study duration.
RESULTS 404 consecutive patients (78.5% female, mean age 42.9 years, mean BMI 44.8 ± 4.7 kg/m2) were enrolled. ESGs were performed using an average of 7 sutures, over 42 ± 9 min, and with 100% technical success. TBWL was 20.9 ± 6.2% at 12 mo, 20.5 ± 6.9% at 24 mo, and 20.3 ± 9.5% at 36 mo. EWL was 49.6 ± 15.1% at 12 mo, 49.4 ± 16.7% at 24 mo, and 47.1 ± 23.5% at 36 mo. There was no difference in TBWL at 12, 15, 24, and 36 mo from ESG. TBWL exceeding 10%, 15%, and 20% was achieved by 96.7%, 87.4%, and 55.6% of the cohort at 12 mo, respectively. Of the cohort with the relevant comorbidity at time of ESG, 66.1% had improvement in hypertension, 61.7% had improvement in type II diabetes, and 45.1% had improvement in hyperlipidemia over study duration. There was one instance of dehydration requiring hospitalization (0.2% serious adverse event rate).
CONCLUSION When combined with longitudinal nutritional support, ESG induces effective and durable weight loss in adults with class III obesity, with improvement in comorbidities and an acceptable safety profile.
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Affiliation(s)
- Daniel Barry Maselli
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Anna Carolina Hoff
- Bariatric Endoscopy, Angioskope Clinic, São José dos Campos 12243-680, São Paulo, Brazil
| | - Ashley Kucera
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Emily Weaver
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Laura Sebring
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Lori Gooch
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kathleen Walton
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Daniel Lee
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Taylor Cratty
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Selena Beal
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Srikar Nanduri
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Kendall Rease
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
| | - Christina S Gainey
- Gastroenterology and Hepatology, University of North Carolina System, Chapel Hill, NC 27599, United States
| | - Laura Eaton
- UltaMed Corporation, UltaMed Corporation, Fort Lauderdale, FL 33308, United States
| | - Brian Coan
- Department of Endobariatrics, True You Weight Loss, Cary, NC 27513, United States
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13
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Inoue T, Yoneda M. Endoscopic intraductal radiofrequency ablation for extrahepatic cholangiocarcinoma: An update (2023). World J Gastrointest Endosc 2023; 15:440-446. [PMID: 37397976 PMCID: PMC10308276 DOI: 10.4253/wjge.v15.i6.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/15/2023] [Accepted: 05/12/2023] [Indexed: 06/14/2023] [Imported: 07/06/2023] Open
Abstract
Recently, endoscopic intraductal radiofrequency ablation (ID-RFA) has attracted attention as a local treatment method for malignant biliary obstruction (MBO). ID-RFA causes coagulative necrosis of the tumor tissue in the stricture and induces exfoliation. Its effects are expected to extend the patency period of biliary stents and prolong the survival period. Evidence for extrahepatic cholangiocarcinoma (eCCA) is gradually accumulating, and some reports show significant therapeutic effects in eCCA patients without distant metastasis. However, it is still far from an established treatment technique, and many unsolved problems remain. Therefore, when performing ID-RFA in clinical practice, it is necessary to understand and grasp the current evidence well and to operate appropriately for the true benefit of the patients. This paper reviews the current status, issues, and prospects of endoscopic ID-RFA for MBO, especially for eCCA.
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Affiliation(s)
- Tadahisa Inoue
- Department of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Aichi, Japan
| | - Masashi Yoneda
- Department of Gastroenterology, Aichi Medical University, Nagakute 480-1195, Aichi, Japan
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14
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Kume K. Flexible robotic endoscopy for treating gastrointestinal neoplasms. World J Gastrointest Endosc 2023; 15:434-439. [PMID: 37397973 PMCID: PMC10308274 DOI: 10.4253/wjge.v15.i6.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/14/2023] [Accepted: 05/04/2023] [Indexed: 06/14/2023] [Imported: 07/06/2023] Open
Abstract
Therapeutic flexible endoscopic robotic systems have been developed primarily as a platform for endoscopic submucosal dissection (ESD) in the treatment of early-stage gastrointestinal cancer. Since ESD can only be performed by highly skilled endoscopists, the goal is to lower the technical hurdles to ESD by introducing a robot. In some cases, such robots have already been used clinically, but they are still in the research and development stage. This paper outlined the current status of development, including a system by the author’s group, and discussed future challenges.
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Affiliation(s)
- Keiichiro Kume
- Third Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu 8078555, Japan
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15
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Kimchy AV, Ahmad AI, Tully L, Lester C, Sanghavi K, Jennings JJ. Prevalence and clinical risk factors for esophageal candidiasis in non-human immunodeficiency virus patients: A multicenter retrospective case-control study. World J Gastrointest Endosc 2023; 15:480-490. [PMID: 37397972 PMCID: PMC10308277 DOI: 10.4253/wjge.v15.i6.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/20/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Although esophageal candidiasis (EC) may manifest in immunocompetent individuals, there is a lack of consensus in the current literature about predisposing conditions that increase the risk of infection.
AIM To determine the prevalence of EC in patients without human immunodeficiency virus (HIV) and identify risk factors for infection.
METHODS We retrospectively reviewed inpatient and outpatient encounters from 5 regional hospitals within the United States (US) from 2015 to 2020. International Classification of Diseases, Ninth and Tenth Revisions were used to identify patients with endoscopic biopsies of the esophagus and EC. Patients with HIV were excluded. Adults with EC were compared to age, gender, and encounter-matched controls without EC. Patient demographics, symptoms, diagnoses, medications, and laboratory data were obtained from chart extraction. Differences in medians for continuous variables were compared using the Kruskal-Wallis test and categorical variables using chi-square analyses. Multivariable logistic regression was used to identify independent risk factors for EC, after adjusting for potential confounding factors.
RESULTS Of the 1969 patients who had endoscopic biopsies of the esophagus performed from 2015 to 2020, 295 patients had the diagnosis of EC. 177 of 1969 patients (8.99%) had pathology confirming the diagnosis of EC and were included in the study for data collection and further analysis. In comparison to controls, patients with EC had significantly higher rates of gastroesophageal reflux disease (40.10% vs 27.50%; P = 0.006), prior organ transplant (10.70% vs 2%; P < 0.001), immunosuppressive medication (18.10% vs 8.10%; P = 0.002), proton pump inhibitor (48% vs 30%; P < 0.001), corticosteroid (35% vs 17%; P < 0.001), Tylenol (25.40% vs 16.20%; P = 0.019), and aspirin use (39% vs 27.50%; P = 0.013). On multivariable logistic regression analysis, patients with a prior organ transplant had increased odds of EC (OR = 5.81; P = 0.009), as did patients taking a proton pump inhibitor (OR = 1.66; P = 0.03) or corticosteroids (OR = 2.05; P = 0.007). Patients with gastroesophageal reflux disease or medication use, including immunosuppressive medications, Tylenol, and aspirin, did not have a significantly increased odds of EC.
CONCLUSION Prevalence of EC in non-HIV patients was approximately 9% in the US from 2015-2020. Prior organ transplant, proton pump inhibitors, and corticosteroids were identified as independent risk factors for EC.
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Affiliation(s)
- Alexandra V Kimchy
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Akram I Ahmad
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC 20007, United States
| | - Lindsey Tully
- Department of Internal Medicine, Georgetown University School of Medicine, Washington, DC 20007, United States
| | - Connor Lester
- Department of Internal Medicine, Georgetown University School of Medicine, Washington, DC 20007, United States
| | - Kavya Sanghavi
- Department of Biostatistics and Biomedical Informatics, MedStar Research Institute, Hyattsville, MD 20781, United States
| | - Joseph J Jennings
- Department of Gastroenterology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
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16
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Kouladouros K. Applications of endoscopic vacuum therapy in the upper gastrointestinal tract. World J Gastrointest Endosc 2023; 15:420-433. [PMID: 37397978 PMCID: PMC10308278 DOI: 10.4253/wjge.v15.i6.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/15/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023] [Imported: 07/06/2023] Open
Abstract
Endoscopic vacuum therapy (EVT) is an increasingly popular treatment option for wall defects in the upper gastrointestinal tract. After its initial description for the treatment of anastomotic leaks after esophageal and gastric surgery, it was also implemented for a wide range of defects, including acute perforations, duodenal lesions, and postbariatric complications. Apart from the initially proposed handmade sponge inserted using the “piggyback” technique, further devices were used, such as the commercially available EsoSponge and VAC-Stent as well as open-pore film drainage. The reported pressure settings and intervals between the subsequent endoscopic procedures vary greatly, but all available evidence highlights the efficacy of EVT, with high success rates and low morbidity and mortality, so that in many centers it is considered to be a first-line treatment, especially for anastomotic leaks.
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Affiliation(s)
- Konstantinos Kouladouros
- Central Interdisciplinary Endoscopy, Surgical Clinic, Mannheim University Hospital, University of Heidelberg, Mannheim 68167, Baden-Wuerttemberg, Germany
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17
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Wei MT, Zhou MJ, Li AA, Ofosu A, Hwang JH, Friedland S. Multicenter evaluation of recurrence in endoscopic submucosal dissection and endoscopic mucosal resection in the colon: A Western perspective. World J Gastrointest Endosc 2023; 15:458-468. [PMID: 37397977 PMCID: PMC10308275 DOI: 10.4253/wjge.v15.i6.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 06/14/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND While colon endoscopic mucosal resection (EMR) is an effective technique, removal of larger polyps often requires piecemeal resection, which can increase recurrence rates. Endoscopic submucosal dissection (ESD) in the colon offers the ability for en bloc resection and is well-described in Asia, but there are limited studies comparing ESD vs EMR in the West.
AIM To evaluate different techniques in endoscopic resection of large polyps in the colon and to identify factors for recurrence.
METHODS The study is a retrospective comparison of ESD, EMR and knife-assisted endoscopic resection performed at Stanford University Medical Center and Veterans Affairs Palo Alto Health Care System between 2016 and 2020. Knife-assisted endoscopic resection was defined as use of electrosurgical knife to facilitate snare resection, such as for circumferential incision. Patients ≥ 18 years of age undergoing colonoscopy with removal of polyp(s) ≥ 20 mm were included. The primary outcome was recurrence on follow-up.
RESULTS A total of 376 patients and 428 polyps were included. Mean polyp size was greatest in the ESD group (35.8 mm), followed by knife-assisted endoscopic resection (33.3 mm) and EMR (30.5 mm) (P < 0.001). ESD achieved highest en bloc resection (90.4%) followed by knife-assisted endoscopic resection (31.1%) and EMR (20.2%) (P < 0.001). A total of 287 polyps had follow-up (67.1%). On follow-up analysis, recurrence rate was lowest in knife-assisted endoscopic resection (0.0%) and ESD (1.3%) and highest in EMR (12.9%) (P = 0.0017). En bloc polyp resection had significantly lower rate of recurrence (1.9%) compared to non-en bloc (12.0%, P = 0.003). On multivariate analysis, ESD (in comparison to EMR) adjusted for polyp size was found to significantly reduce risk of recurrence [adjusted hazard ratio 0.06 (95%CI: 0.01-0.57, P = 0.014)].
CONCLUSION In our study, EMR had significantly higher recurrence compared to ESD and knife-assisted endoscopic resection. We found factors including resection by ESD, en bloc removal, and use of circumferential incision were associated with significantly decreased recurrence. While further studies are needed, we have demonstrated the efficacy of ESD in a Western population.
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Affiliation(s)
- Mike T Wei
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA 94306, United States
| | - Margaret J Zhou
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA 94306, United States
| | - Andrew A Li
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA 94306, United States
| | - Andrew Ofosu
- Department of Gastroenterology, University of Cincinnati College of Medicine, Cincinnati, OH 45267, United States
| | - Joo Ha Hwang
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA 94306, United States
| | - Shai Friedland
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA 94306, United States
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18
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Rajivan R, Thayalasekaran S. Improving polyp detection at colonoscopy: Non-technological techniques. World J Gastrointest Endosc 2023; 15:354-367. [PMID: 37274557 PMCID: PMC10236979 DOI: 10.4253/wjge.v15.i5.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/03/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] [Imported: 07/06/2023] Open
Abstract
Colonoscopy and polypectomy remain the gold standard investigation for the detection and prevention of colorectal cancer. Halting the progression of colonic adenoma through adequate detection of pre-cancerous lesions interrupts the progression to carcinoma. The adenoma detection rate is a key performance indicator. Increasing adenoma detection rates are associated with reducing rates of interval colorectal cancer. Endoscopists with high baseline adenoma detection rate have a meticulous technique during colonoscopy withdrawal that improves their adenoma detection. This minireview article summarizes the evidence on the following simple operator techniques and their effects on the adenoma detection rate; minimum withdrawal times, dynamic patient position change and proximal colon retroflexion.
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Affiliation(s)
- Ragul Rajivan
- Buckingham Medical School, Milton Keynes MK18 1EG, United Kingdom
| | - Sreedhari Thayalasekaran
- Department of Gastroenterology, University Hospitals of Leicester, Leicester LE1 5WW, United Kingdom
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Mi SC, Wu LY, Xu ZJ, Zheng LY, Luo JW. Effect of modified ShengYangYiwei decoction on painless gastroscopy and gastrointestinal and immune function in gastric cancer patients. World J Gastrointest Endosc 2023; 15:376-385. [PMID: 37274559 PMCID: PMC10236977 DOI: 10.4253/wjge.v15.i5.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/28/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Painless gastroenteroscopy is a widely developed diagnostic and treatment technology in clinical practice. It is of great significance in the clinical diagnosis, treatment, follow-up review and other aspects of gastric cancer patients. The application of anesthesia techniques during manipulation can be effective in reducing patient fear and discomfort. In clinical work, the adverse drug reactions of anesthesia regimens and the risk of serious adverse drug reactions are increased with the increase in propofol application dose application dose; the application of opioid drugs often causes gastrointestinal reactions, such as nausea, vomiting and delayed gastrointestinal function recovery, after examination. These adverse effects can seriously affect the quality of life of patients.
AIM To observe the effect of modified ShengYangYiwei decoction on gastrointestinal function, related complications and immune function in patients with gastric cancer during and after painless gastroscopy.
METHODS A total of 106 patients with gastric cancer, who were selected from January 2022 to September 2022 in Xiamen Traditional Chinese Medicine Hospital for painless gastroscopy, were randomly divided into a treatment group (n = 56) and a control group (n = 50). Before the examination, all patients fasted for 8 h, provided their health education, and confirmed if there were contraindications to anesthesia and gastroscopy. During the examination, the patients were placed in the left decubitus position, the patients were given oxygen through a nasal catheter (6 L/min), the welling needle was opened for the venous channel, and a multifunction detector was connected for monitoring electrocardiogram, oxygen saturation, blood pressure, etc. Naporphl and propofol propofol protocols were used for routine anesthesia. Before anesthesia administration, the patients underwent several deep breathing exercises, received intravenous nalbuphine [0.nalbuphine (0.025 mg/kg)], followed by intravenous propofol [1.propofol (1.5 mg/kg)] until the palpebral reflex disappeared, and after no response, gastroscopy was performed. If palpebral reflex disappeared, and after no response, gastroscopy was performed. If any patient developed movement, frowning, or hemodynamic changes during the operation (heart rate changes during the operation (heart rate increased to > 20 beats/min, systolic blood pressure increased to > 20% of the base value), additional propofol [0.propofol (0.5 mg/kg)] was added until the patient was sedated again. The patients in the treatment group began to take the preventive intervention of Modified ShengYangYiwei decoction one week before the examination, while the patients in the control group received routine gastrointestinal endoscopy. The patients in the two groups were examined by conventional painless gastroscopy, and the characteristics of the painless gastroscopies of the patients in the two groups were recorded and compared. These characteristics included the total dosage of propofol during the examination, the incidence of complications during the operation, the time of patients' awakening, the time of independent activities, and the gastrointestinal function of the patients after examination, such as the incidence of reactions such as malignant vomiting, abdominal distension and abdominal pain, as well as the differences in the levels of various immunological indicators and inflammatory factors before anesthesia induction (T0), after conscious extubation (T1) and 24 h after surgery (T2).
RESULTS There was no difference in the patients’ general information, American Society of Anesthesiologist classification or operation time between the two groups before treatment. In terms of painless gastroscopy, the total dosage of propofol in the treatment group was lower than that in the control group (P < 0.05), and the time of awakening and autonomous activity was significantly faster than that in the control group (P < 0.05). During the examination, the incidence of hypoxemia, hypotension and hiccups in the treatment group was significantly lower than that in the control group (P < 0.01). In terms of gastrointestinal function, the incidences of nausea, vomiting, abdominal distension and abdominal pain in the treatment group after examination were significantly lower than those in the control group (P < 0.01). In terms of immune function, in both groups, the number of CD4+ and CD8+ cells decreased significantly (P < 0.05), and the number of natural killer cells increased significantly (P < 0.05) at T1 and T2, compared with T0. The number of CD4+ and CD8+ cells in the treatment group at the T1 and T2 time points was higher than that in the control group (P < 0.05), while the number of natural killer cells was lower than that in the control group (P < 0.05). In terms of inflammatory factors, compared with T0, the levels of interleukin (IL) -6 and tumor necrosis factor-alpha in patients in the two groups at T1 and T2 increased significantly and then decreased (P < 0.05). The level of IL-6 at T1 and T2 in the treatment group was lower than that in the control group (P < 0.05).
CONCLUSION The preoperative use of modified ShengYangYiwei decoction can optimize the anesthesia program during painless gastroscopy, improve the gastrointestinal function of patients after the operation, reduce the occurrence of examination-related complications.
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Affiliation(s)
- Sui-Cai Mi
- Department of Oncology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen 361000, Fujian Province, China
| | - Ling-Yan Wu
- Department of Nephropathy, Xiamen Hospital of Traditional Chinese Medicine, Xiamen 361000, Fujian Province, China
| | - Zheng-Jin Xu
- Department of Nephropathy, Xiamen Hospital of Traditional Chinese Medicine, Xiamen 361000, Fujian Province, China
| | - Li-Yan Zheng
- Department of Anesthesiology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen 361000, Fujian Province, China
| | - Jian-Wen Luo
- Department of Oncology, Xiamen Hospital of Traditional Chinese Medicine, Xiamen 361000, Fujian Province, China
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Keating E, Leyden J, O'Connor DB, Lahiff C. Unlocking quality in endoscopic mucosal resection. World J Gastrointest Endosc 2023; 15:338-353. [PMID: 37274555 PMCID: PMC10236981 DOI: 10.4253/wjge.v15.i5.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] [Imported: 07/06/2023] Open
Abstract
A review of the development of the key performance metrics of endoscopic mucosal resection (EMR), learning from the experience of the establishment of widespread colonoscopy quality measurements. Potential future performance markers for both colonoscopy and EMR are also evaluated to ensure continued high quality performance is maintained with a focus service framework and predictors of patient outcome.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Jan Leyden
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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Keating E, Bennett G, Murray MA, Ryan S, Aird J, O'Connor DB, O'Toole D, Lahiff C. Rectal neuroendocrine tumours and the role of emerging endoscopic techniques. World J Gastrointest Endosc 2023; 15:368-375. [PMID: 37274556 PMCID: PMC10236980 DOI: 10.4253/wjge.v15.i5.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/23/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023] [Imported: 07/06/2023] Open
Abstract
Rectal neuroendocrine tumours represent a rare colorectal tumour with a 10 fold increased prevalence due to incidental detection in the era of colorectal screening. Patient outcomes with early diagnosis are excellent. However endoscopic recognition of this lesion is variable and misdiagnosis can result in suboptimal endoscopic resection with subsequent uncertainty in relation to optimal long-term management. Endoscopic techniques have shown particular utility in managing this under-recognized neuroendocrine tumour.
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Affiliation(s)
- Eoin Keating
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Gayle Bennett
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Michelle A Murray
- School of Medicine, University College Dublin, Dublin 4, Ireland
- National Lung Transplant Unit, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Sinead Ryan
- Department of Pathology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - John Aird
- School of Medicine, University College Dublin, Dublin 4, Ireland
- Department of Pathology, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Donal B O'Connor
- Department of Surgery, Tallaght University Hospital, Dublin 24, Ireland
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
| | - Dermot O'Toole
- School of Medicine, Trinity College Dublin, Dublin 2, Ireland
- Department of Clinical Medicine and Gastroenterology, St. James Hospital, Dublin 8, Ireland
| | - Conor Lahiff
- Department of Gastroenterology, Mater Misericordiae University Hospital, Dublin 7, Ireland
- School of Medicine, University College Dublin, Dublin 4, Ireland
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Patel AP, Khalaf MA, Riojas-Barrett M, Keihanian T, Othman MO. Expanding endoscopic boundaries: Endoscopic resection of large appendiceal orifice polyps with endoscopic mucosal resection and endoscopic submucosal dissection. World J Gastrointest Endosc 2023; 15:386-396. [PMID: 37274558 PMCID: PMC10236978 DOI: 10.4253/wjge.v15.i5.386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023] [Imported: 07/06/2023] Open
Abstract
BACKGROUND Large appendiceal orifice polyps are traditionally treated surgically. Recently, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been utilized as alternative resection techniques.
AIM To evaluate the efficacy and safety of endoscopic resection techniques for the management of large appendiceal orifice polyps.
METHODS This was a retrospective observational study conducted to assess the feasibility and safety of EMR and ESD for large appendiceal orifice polyps. This project was approved by the Baylor College of Medicine Institutional Review Board. Patients who underwent endoscopic resection of appendiceal orifice polyps ≥ 1 cm from 2015 to 2022 at a tertiary referral endoscopy center in the United States were enrolled. The main outcomes of this study included en bloc resection, R0 resection, post resection adverse events, and polyp recurrence.
RESULTS A total of 19 patients were identified. Most patients were female (53%) and Caucasian (95%). The mean age was 63.3 ± 10.8 years, and the average body mass index was 28.8 ± 6.4. The mean polyp size was 25.5 ± 14.2 mm. 74% of polyps were localized to the appendix (at or inside the appendiceal orifice) and the remaining extended into the cecum. 68% of polyps occupied ≥ 50% of the appendiceal orifice circumference. The mean procedure duration was 61.6 ± 37.9 minutes. Polyps were resected via endoscopic mucosal resection, endoscopic submucosal dissection, and hybrid procedures in 5, 6, and 8 patients, respectively. Final pathology was remarkable for tubular adenoma (n = 10) [one with high grade dysplasia], sessile serrated adenoma (n = 7), and tubulovillous adenoma (n = 2) [two with high grade dysplasia]. En bloc resection was achieved in 84% with an 88% R0 resection rate. Despite the large polyp sizes and challenging procedures, 89% (n = 17) of patients were discharged on the same day as their procedure. Two patients were admitted for post-procedure observation for conservative pain management. Eight patients underwent repeat colonoscopy without evidence of residual or recurrent adenomatous polyps.
CONCLUSION Our study highlights how endoscopic mucosal resection, endoscopic submucosal dissection, and hybrid procedures are all appropriate techniques with minimal adverse effects, further validating the utility of endoscopic procedures in the management of large appendiceal polyps.
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