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Payza AD, Hoşgör M, Serdaroğlu E, Sencan A. Can distal ureteral diameter measurement predict primary vesicoureteral reflux clinical outcome and success of endoscopic injection? J Pediatr Urol 2019; 15:515.e1-8. [PMID: 31420285 DOI: 10.1016/j.jpurol.2019.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/08/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the predictive value of distal ureteral diameter ratio (UDR) on outcome of primary vesicoureteral reflux (VUR) and reflux resolution after endoscopic injection. PATIENTS AND METHODS Three hundred eighty-three patients treated for primary VUR between January 2010 and October 2015 were retrospectively reviewed. The parameters analyzed were age at diagnosis, sex, grade and lateralite of VUR, complaints at admission (febrile urinary tract infection, antenatal hydronephrosis, family history),bladder-bowel dysfunction (urgency, incontinence, constipation), dimercaptosuccinic acid (DMSA) scintigraphy findings, follow-up period, clinical course (spontaneous resolution or surgical correction), time of spontaneous resolution, surgical treatment time and age, materials used for injection and success of endoscopic injection. Ureteral diameter ratio was calculated on the initial VCUG at the time of the diagnosis as the largest ureteral diameter within the false pelvis divided by the distance between L1-L3.The correlation between UDR, clinical outcome (spontaneous resolution/surgical correction) and success of endoscopic injection was evaluated by logistic regression analysis. To compare the effect of UDR and grade of reflux on spontaneous resolution, multivariate logistic regression analysis was performed in three models together with sex, age, resolution time, presence of febrile UTI and DMSA scan findings. RESULTS Three hundred eighty-three patients were enrolled. There was a strong correlation between UDR and grade of reflux (p < 0,0001). Ureteral diameter ratio was higher in patients whose complaints at admission were family history and febrile UTI, but this correlation was not statistically significant (p > 0.05). When the correlation between UDR and the DMSA scan findings was evaluated, UDR was found to be significantly higher in patients with moderate and severe scarring. Bladder-bowel dysfunction was present in 111 patients (28.9%). There was no significant correlation between BBD and UDR (p > 0.05). 62 patients showed spontaneous resolution in a median duration of 1.55 years. The predictive value of UDR for spontaneous resolution was more significant than grade (p < 0.001).There was no spontaneous resolution in patients with UDR over 0.45.321 patients underwent operation (248 endoscopic injection, 17 ureteroneocystostomy, 56 endoscopic injection+ureteroneocystostomy). When the predictive value of the reflux grade and UDR in the success rate of endoscopic correction was compared, UDR was shown to be significantly more predictive than the grade of reflux (p < 0.05). Ureteral diameter ratio was significantly higher in patients whose injection treatment was unsuccessful. Each 0.05 unit increase in UDR affected the success of endoscopic injection negatively (95% CI:<0.001-0.071). CONCLUSION Ureteral diameter ratio is an objective measurement of VUR and appears to be a new predictive tool for clinical outcome and success after endoscopic injection.
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Neermark S, Rasmussen D, Rysgaard S, Gluud LL, Novovic S, Schmidt PN. The cost of endoscopic treatment for walled-off pancreatic necrosis. Pancreatology 2019; 19:828-33. [PMID: 31383574 DOI: 10.1016/j.pan.2019.07.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/12/2019] [Accepted: 07/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Use of minimally invasive techniques has reduced mortality in walled-off pancreatic necrosis (WON) but may be costly. The aim of this study was to evaluate the actual costs associated with the endoscopic management of patients with WON. METHODS We included a retrospective cohort of WON patients treated with endoscopic, transgastric drainage and necrosectomy (ETDN) during 2013-2014. Costs were calculated for six sub-areas based on a micro-costing model. Students T-test and non-parametric analysis of variance were performed to evaluate costs in relation to disease etiology and outcome. RESULTS We included 58 patients (50% men, median age 57 years). The most common etiologies were gallstones (57%) and alcohol (19%). Nine patients (16%) died during admission. The median length of stay was 50 days (IQR 31 days). Eighteen patients (31%) needed treatment in our intensive care unit with a median length of stay of 16 days (IQR 31 days). The mean costs and standard deviation of costs (SD) per patient were: diagnostic imaging $2,431 ($2,301), laboratory tests $3,579 ($2,477), blood products $982 ($1,734), endoscopic treatment $3,794 ($1,777), medicine $5,440 ($6,656), and ward cost $41,260 ($35,854). The mean total cost was $57,486 ($46,739). Post-ERCP pancreatitis and mortality predicted higher costs. CONCLUSIONS This study sheds light on the different costs associated with endoscopic treatment of WON. As nearly three quarters of the costs are related to ward care, initiatives aimed at reducing the length of hospital stay may have a great impact on making endoscopic treatment more cost effective.
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Carrillo Arroyo I, Fuentes Carretero S, Gómez Fraile A, Morante Valverde R, Tordable Ojeda C, Cabezalí Barbancho D. Technical challenges of endoscopic treatment for vesicoureteral reflux after Cohen reimplantation. Actas Urol Esp 2019; 43:384-388. [PMID: 31103394 DOI: 10.1016/j.acuro.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/06/2019] [Accepted: 02/16/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The range of indications for endoscopic treatment of vesicoureteral reflux opens more and more until including correction of secondary reflux (VUR) after ureteral reimplantation. However these cases suppose a technical challenge due to postoperative changes. The aim of this work is to present our experience on endoscopic treatment for VUR in ureteral units with Cohen reimplantation surgery, with special interest in the technical peculiarities of the procedure. MATERIAL AND METHODS A retrospective study of cases of secondary VUR after reimplantation surgery treated by subureteral injection. TECHNIQUE We put the needle perpendicular to submucous tunnel and inject medially to hole forming a wheal on the anterior face that occludes the meatus RESULTS: During the 1993-2016 period 21 injections were performed in 15 ureteral units. The ureteral pathology included primary VUR (4), duplex system with lower pole reflux (4), megaureter (3) and ureterocele (2). Average patient age was 5.7 years old (2-12). Succesful outcome had been got in 10 ureteral units (66.67%), a decrease of VUR grade in 4 (26.67%) and perseverance/no resolution of grade IV VUR in 1 (6.67%) DISCUSSION: The anti-reflux mechanism of reimplantation depends on optimizing the submucosous tunnel. This subgroup of pacients is small and there are few studies, hindering the agreement on the most appropiate technique. CONCLUSION Endoscopic treatment of secondary reflux after reimplantation surgery is a procedure with certain technical feature, but safe and effective offering an alternative prior to surgical reoperation.
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Yang X, Zong Y, Zhao HY, Wu YD, Ji M. Complete excision of esophageal bronchogenic cyst by endoscopic submucosal tunnel dissection: a case presentation. BMC Gastroenterol 2019; 19:155. [PMID: 31462259 PMCID: PMC6714396 DOI: 10.1186/s12876-019-1072-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/19/2019] [Indexed: 01/13/2023] Open
Abstract
Background Intramural esophageal bronchogenic cyst is very rare. Surgical removal of the cysts is advised even the patients are asymptomatic, since the cyst can lead to complications, and there is a risk of malignant transformation. Thoracotomy or thoracoscopy is the most commonly used approach for complete excision of the cysts. To our knowledge, this is the first report to excise intramural esophageal bronchogenic cyst completely by endoscopic submucosal tunnel dissection (ESTD). Case presentation A 40-year-old male was referred to our hospital due to the detection of a submucosal tumor at the distal esophagus. The tumor was found during gastroendoscopy in a general health check-up. The patient had no symptoms. A benign esophageal tumor was confirmed by endoscopic ultrasonography (EUS) and computed tomography (CT). On the basis of these results, ESTD was performed. During the procedure, a cystic mass was observed between the mucosa and the muscular layers of the esophagus, and a hybrid knife was used for dissection. Histopathological examination showed the cyst wall was lined by pseudostratified ciliated columnar epithelium, consistent with a bronchogenic cyst. The esophagography using meglumine diatrizoate showed no leakage on the seventh day after ESTD. The patient remained asymptomatic and had a regular diet during the follow-up period. Discussion and conclusions We successfully utilized ESTD for complete removal of esophageal bronchogenic cysts originating from the muscularis propria. The approach appeared safe, providing a minimally invasive treatment option for patients.
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Affiliation(s)
- Xun Yang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Ye Zong
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Hai-Ying Zhao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Yong-Dong Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Ming Ji
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, No.95 Yongan Road, Xicheng District, Beijing, 100050, China.
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Velotti N, Manigrasso M, Di Lauro K, Araimo E, Calculli F, Vertaldi S, Anoldo P, Aprea G, Simone GD, Vitiello A, Musella M, Milone M, De Palma GD, Milone F, Sosa Fernandez LM. Minimally Invasive Pilonidal Sinus Treatment: A Narrative Review. Open Med (Wars) 2019; 14:532-536. [PMID: 31428682 PMCID: PMC6698053 DOI: 10.1515/med-2019-0059] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022] Open
Abstract
The management of chronic pilonidal disease remains controversial, but recently, new minimal invasive approaches have been proposed. Whereas in the conventional surgical treatment an elliptical wedge of skin and subcutaneous tissue is created to remove the sinus and its lateral tracks, the basis for our new treatment is to create a minimal elliptical wedge of the subcutaneous tissue, including all the inflamed tissue and debris while leaving the overlying skin intact. The mechanism of an endoscopic approach relies on use of the endoscope without cutaneous tissue damage. Advantages include shorter operative time and time to discharge, which impact resource management in both primary and secondary care: patients undergoing endoscopic technique have a high satisfaction rate, probably due to the low level of postoperative pain and early return to work and daily activities. However, it is mandatory that further studies would analyze surgical approaches to pilonidal sinus disease (PSD) with a consistent and adequate follow-up of at least 5 years. Both sinusectomy and endoscopic approach to PSD were found to be safe and effective compared with conventional techniques. Publishedresults of studies of newer approaches have demonstrated a low short-term complication rate, comparable to conventional surgery results.
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Affiliation(s)
- Nunzio Velotti
- Department of Advanced Biomedical Sciences, "Federico II" University, Via S. Pansini 5, 80131, Naples, Italy
| | - Michele Manigrasso
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Katia Di Lauro
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Enrico Araimo
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Federica Calculli
- Department of Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Sara Vertaldi
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Pietro Anoldo
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanni Aprea
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Giuseppe De Simone
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Antonio Vitiello
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Mario Musella
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Marco Milone
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanni Domenico De Palma
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Francesco Milone
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Loredana Maria Sosa Fernandez
- Department of Clinical Medicine and Surgery. University "Federico II" of Naples, Via S. Pansini 5, 80131 Naples, Italy
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Wang RG, Jiang X, Ren YT, Wang J, Guo XJ. [Analysis on risk factors of positive vertical resection margin after endoscopic treatment of rectal neuroendocrine tumors]. Zhonghua Wei Chang Wai Ke Za Zhi 2019; 22:643-7. [PMID: 31302962 DOI: 10.3760/cma.j.issn.1671-0274.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyze the risk factors of positive vertical resection margin of the postoperative specimens after endoscopic treatment of rectal neuroendocrine tumors (NET). Methods: A case-control study was performed. Clinical data of patients with rectal NET (G1) undergoing endoscopic treatment between January 2015 and June 2018 at the Department of Gastroenterology, Beijing Tsinghua Changgung Hospital were retrospectively collected. Inclusion criteria: cases underwent endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), whose mucosal specimens were pathologically confirmed as NET, and NET was confined to the rectum by nuclide imaging examination before endoscopic treatment. Those with incomplete clinical data or follow-up data were excluded. Resected specimen was fixed and sliced every 2 mm, and when tumor cells were found to infiltrate the vertical cutting edge, the positive vertical margin was defined. Associations of gender, age, resection method, tumor diameter, lesion morphology (nodular lesions, biopsy or post-treatment scar-like changes), mitotic figure, Ki-67 index, etc. and positive vertical margin were analyzed. Univariate analysis was performed using binary logistic analysis and multivariate analysis was performed using logistic regression model. Results: A total of 133 patients with rectal NET were enrolled, including 93 males and 40 females, with an average age of (50.0±10.7) years. Sixty-four patients received EMR treatment and 3 patients (4.7%) had positive vertical margins. While 69 patients received ESD treatment and 13 (18.8%) had positive vertical margins. After endoscopic treatment, 16 cases (12.0%) were vertical positive margin, including 11 males and 5 females with an average age of (52.4±10.4) years. The lesion diameter was (9.0±4.7) mm. Univariate analysis showed that lesion diameter ≥10 mm (χ(2)=5.575, P=0.018) and scar-like changes (χ(2)=3.894, P=0.048) were significantly associated with positive vertical margin. Multivariate analysis showed that the lesion diameter ≥10 mm (OR=10.136, 95%CI: 2.114 to 48.591, P=0.004) was an independent risk factor for positive vertical margin of the specimen after endoscopic treatment of rectal NET. Conclusion: The diameter of rectal NET ≥10 mm indicates a high risk for positive vertical margin after endoscopic treatment.
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He L, Ye X, Ma J, Li P, Jiang Y, Hu J, Yang J, Zhou Y, Liang X, Lin Y, Wei H. Antiviral therapy reduces rebleeding rate in patients with hepatitis B-related cirrhosis with acute variceal bleeding after endotherapy. BMC Gastroenterol 2019; 19:101. [PMID: 31226942 PMCID: PMC6588843 DOI: 10.1186/s12876-019-1020-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 06/11/2019] [Indexed: 12/15/2022] Open
Abstract
Background The preventive effects of antiviral therapy to reduce rebleeding rate in patients with hepatitis B-related cirrhosis undergoing endoscopic treatment have not yet been reported. Methods In this retrospective cohort study, 1139 patients with chronic hepatitis B with first acute variceal bleeding after endoscopic therapy from September 2008 to December 2017 were included. Among them, 923 who received and 216 who did not receive antiviral therapy were followed up for rebleeding. Cumulative rebleeding rate was calculated using the Kaplan-Meier method. Univariate and multivariate logistic regression analyses were performed to estimate the effects of antiviral therapy on rebleeding risk. The propensity score matched method and inverse probability of treatment weighting analysis were used to calculate the rebleeding rate between the antiviral and non-antiviral groups. Results The rebleeding rates were 40.5, 60.7, 72.6, and 89.2% in antiviral group at 1, 2, 3, and 5 years, respectively. The corresponding rebleeding rates in the non-antiviral group were 54.2, 72.4, 84.4, and 93.3%, respectively. The multivariate logistic regression analysis revealed that antiviral therapy was an independent protective factor associated with rebleeding. Conclusion Antiviral treatment significantly reduced rebleeding rate in patients with HBV-related cirrhosis who received endoscopic treatment after the first variceal bleeding. Electronic supplementary material The online version of this article (10.1186/s12876-019-1020-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lingling He
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Xiaohui Ye
- Beijing Huaxin Hospital, the First Affiliated Hospital of Tsinghua Uinversity, Beijing, China
| | - Jiali Ma
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Ping Li
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yu Jiang
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Julong Hu
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Junru Yang
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yuling Zhou
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Xiuxia Liang
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yijun Lin
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Hongshan Wei
- Department of gastroenterology, Beijing Ditan Hospital, Capital Medical University, No.8, Jingshun East Street, Chaoyang District, Beijing, 100015, China.
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García-Compeán D, Del Cueto-Aguilera ÁN, Jiménez-Rodríguez AR, González-González JA, Maldonado-Garza HJ. Diagnostic and therapeutic challenges of gastrointestinal angiodysplasias: A critical review and view points. World J Gastroenterol 2019; 25:2549-2564. [PMID: 31210709 PMCID: PMC6558444 DOI: 10.3748/wjg.v25.i21.2549] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/19/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal angiodysplasias (GIADs), also called angioectasias, are the most frequent vascular lesions. Its precise prevalence is unknown since most of them are asymptomatic. However, the incidence may be increasing since GIADs affect individuals aged more than 60 years and population life expectancy is globally increasing worldwide. They are responsible of about 5% to 10% of all gastrointestinal bleeding (GIB) cases. Most GIADs are placed in small bowel, where are the cause of 50 to 60% of obscure GIB diagnosed with video capsule endoscopy. They may be the cause of fatal severe bleeding episodes; nevertheless, recurrent overt or occult bleeding episodes requiring repeated expensive treatments and disturbing patient’s quality-of-life are more frequently observed. Diagnosis and treatment of GIADs (particularly those placed in small bowel) are a great challenge due to insidious disease behavior, inaccessibility to affected sites and limitations of available diagnostic procedures. Hemorrhagic causality out of the actively bleeding lesions detected by diagnostic procedures may be difficult to establish. No treatment guidelines are currently available, so there is a high variability in the management of these patients. In this review, the epidemiology and pathophysiology of GIADs and the status in the diagnosis and treatment, with special emphasis on small bowel angiodysplasias based on multiple publications, are critically discussed. In addition, a classification of GIADs based on their endoscopic characteristics is proposed. Finally, some aspects that need to be clarified in future research studies are highlighted.
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Affiliation(s)
- Diego García-Compeán
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Ángel N Del Cueto-Aguilera
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Alan R Jiménez-Rodríguez
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - José A González-González
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Héctor J Maldonado-Garza
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, Mexico
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Yamaguchi S, Sasaki K, Kato H, Fukudo S, Iwakiri R, Kamiya T, Motoya S, Murakami K, Nagahara A, Suzuki H, Watanabe T, Takahashi S, Chan FKL, Hahm KB, Kachintorn U, Ming FK, Rani AA, Sollano JD, Zhu Q. Questionnaire-Based Survey on Management of Ulcerative Colitis-Associated Cancer in East Asian Countries. Digestion 2019; 99:86-94. [PMID: 30554204 DOI: 10.1159/000494419] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS To elucidate the current management of ulcerative colitis (UC)-associated cancer, a questionnaire-based survey was conducted to gather current opinions on colitis-associated cancer in different East Asian countries. METHODS The questionnaire, based on physicians, contains 9 questions focused on UC management and cancer surveillance. In addition, the questionnaire based on neoplastic cases, which contains 17 questions, was collected and analyzed. RESULTS With regard to the diagnosis of UC-associated cancer, most respondents started surveillance colonoscopy within 10 years from onset, favored targeted biopsies, and thought advanced imaging was useful. As for morphology, the frequency of elevated lesion and type 4 lesions was most common in early and advanced cancer, respectively. Peritoneal metastasis was frequently observed, and undifferentiated tumor was frequently developed. Laparoscopic surgery was widely used because it is less invasive. The prognostic outcome was poor, particularly in stage III and undifferentiated type. CONCLUSIONS The current survey elucidated the current management in Asian countries and characteristics of colitis-associated cancer in these countries.
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Affiliation(s)
- Satoru Yamaguchi
- Department of Surgery I, Dokkyo Medical University, Tochigi, Japan,
| | - Kinro Sasaki
- Department of Surgery I, Dokkyo Medical University, Tochigi, Japan
| | - Hiroyuki Kato
- Department of Surgery I, Dokkyo Medical University, Tochigi, Japan
| | - Shin Fukudo
- Tohoku University Graduate School of Medicine, Miyagi, Japan
| | | | - Takeshi Kamiya
- Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | | | | | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hidekazu Suzuki
- Fellowship Training Center and Medical Education Center, Keio University School of Medicine, Tokyo, Japan
| | - Toshio Watanabe
- Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Francis K L Chan
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ki-Baik Hahm
- Digestive Disease Center, CHA University School of Medicine and CHA University Bundang Medical Center, Seoul, Republic of Korea
| | - Udom Kachintorn
- Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital Mahidol University, Bangkok, Thailand
| | - Fock Kwong Ming
- Department of Gastroenterology, Changi General Hospital, Singapore, Singapore
| | - Abdul Aziz Rani
- Department of Internal Medicine, Faculty of Medicine, University of Indonesia Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | - Qi Zhu
- Sino United Health Clinic, Gopher Medical Center, Rui Jing Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Takita M, Sakai E, Nakao T, Kimoto Y, Ishii R, Konishi T, Ueno S, Kanda K, Negishi R, Muramoto T, Hashimoto H, Morikawa T, Matsuhashi N, Ohata K. Clinical Outcomes of Patients with Small Rectal Neuroendocrine Tumors Treated Using Endoscopic Submucosal Resection with a Ligation Device. Digestion 2019; 99:72-78. [PMID: 30554202 DOI: 10.1159/000494416] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS The therapeutic strategies for small rectal neuroendocrine tumors (NETs) have not been standardized. We examined the efficacy and safety of endoscopic submucosal resection with a ligation device (ESMR-L) and the long-term outcomes after endoscopic treatment. METHODS A total of 181 patients with rectal NETs <10 mm who were treated between May 2002 and May 2017 were retrospectively enrolled. All the lesions had been resected using ESMR-L, and the follow-up strategies were determined according to the pathological examinations. The long-term outcomes after a 53-month follow-up period were also evaluated. RESULTS R0 resection was achieved in 180 cases (99.4%). Lymphovascular invasion was confirmed in 67 cases (37.0%), while a curative resection was achieved in 114 cases (63.0%). One perforation (0.6%) and 11 cases with delayed bleeding (6.1%) were observed. A multivariate logistic regression analysis revealed that a tumor size > 5 mm (OR 2.06; 95% CI 1.04-4.08, p = 0.04) was a significant independent predictor of the presence of lymphovascular invasion. Of the 67 patients with non-curative resections, 11 patients underwent additional surgery; lymph node metastasis was confirmed in 2 cases (18.2%). No local or distant metastases were observed during the follow-up period in 77 patients with a curative resection, 9 patients who received additional surgery, and 50 patients with non-curative resections. CONCLUSION ESMR-L is an easy, safe and effective treatment for rectal NETs <10 mm in diameter, and the prognosis of patients seems to be good, despite a relatively high rate of lymphovascular invasion.
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Affiliation(s)
- Maiko Takita
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Eiji Sakai
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Tomomi Nakao
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yoshiaki Kimoto
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Rindo Ishii
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takafumi Konishi
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Sakaya Ueno
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Keisuke Kanda
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Ryoju Negishi
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | - Takashi Muramoto
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Teppei Morikawa
- Department of Pathology, NTT Medical Center Tokyo, Tokyo, Japan
| | | | - Ken Ohata
- Department of Gastroenterology, NTT Medical Center Tokyo, Tokyo, Japan,
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111
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Meinero P, La Torre M, Lisi G, Stazi A, Carbone A, Regusci L, Fasolini F. Endoscopic pilonidal sinus treatment (EPSiT) in recurrent pilonidal disease: a prospective international multicenter study. Int J Colorectal Dis 2019; 34:741-746. [PMID: 30719564 DOI: 10.1007/s00384-019-03256-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pilonidal disease (PD) is a common disease of the natal cleft, which can lead to complications including infection and abscess formation. Various operative management options are available, but the ideal technique is still debatable. Recurrent PD after surgical treatment is frequent event for the 25-30% of cases. The present study evaluated endoscopic pilonidal sinus treatment (EPSiT) in recurrent and multi-recurrent PD. METHODS Of the consecutive prospective patients with recurrent PD, 122 were enrolled in a prospective international multicenter study conducted at a secondary and tertiary colorectal surgery centers. Primary endpoint was to evaluate short- and long-term outcomes: healing rate/time, morbidity rate, re-recurrence rate, and patient's quality of life (QoL). RESULTS Complete wound healing rate was occurred in 95% of the patient, with a mean complete wound healing time of 29 ± 12 days. The incomplete healing rate (5%) was significantly related to the number of external openings (p = 0.008), and recurrence was reported in six cases (5.1%). Normal daily activity was established on the first postoperative day, and the mean duration before patients returned to work was 3 days. QoL significantly increased between the preoperative stage and 30 days after the EPSiT procedure (45.3 vs. 7.9; p < 0.0001). CONCLUSIONS The EPSiT procedure seems to be a safe and effective technique in treating even complex recurrent PD. It enables excellent short- and long-term outcomes than various other techniques that are more invasive.
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Affiliation(s)
- Piercarlo Meinero
- Colorectal Unit Sanatrix Clinic, Rome, Italy.,Department of Surgery, EOC Hospital, Mendrisio, Switzerland
| | - Marco La Torre
- Colorectal Unit Sanatrix Clinic, Rome, Italy.,General Surgery and Proctology, University Pittsburgh Medical Center - Salvator Mundi International Hospital, Rome, Italy
| | - Giorgio Lisi
- Department of Surgery, Sant'Eugenio Hospital, Rome, Italy. .,Department of General Surgery, Sant'Eugenio Hospital, Rome, Italy.
| | - Alessandro Stazi
- Pelvic Care Center, Madonna delle Grazie Hospital, Velletri, Rome, Italy
| | - Antonella Carbone
- Colorectal Unit Sanatrix Clinic, Rome, Italy.,Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Luca Regusci
- Department of Surgery, EOC Hospital, Mendrisio, Switzerland
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112
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Yu L, Shang GC, Chen LN, Chen WG. Comparative analysis of tracheal intubation anesthesia vs non-tracheal intubation anesthesia for endoscopic treatment of esophago-gastric varices. Shijie Huaren Xiaohua Zazhi 2019; 27:299-304. [DOI: 10.11569/wcjd.v27.i5.299] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal-gastro varices (EGV) is one of the common complications of cirrhosis, and esophageal gastric variceal bleeding (EGVB), characterized by acute onset and high severity, is one of the main causes of death in patients with cirrhosis. Painless endoscopic treatment is an important measure for the management of EGV rupture. At present, there are two ways of anesthesia: endotracheal intubation and non-tracheal intubation anesthesia.
AIM To compare the safety and economy of endotracheal intubation and non-tracheal intubation anesthesia for endoscopic treatment of EGV.
METHODS The study was performed in 58 patients with inactive bleeding who underwent endoscopic treatment for EGV from September 2017 to August 2018. They were randomly divided into an intravenous anesthesia group (non-intubation group) and a tracheal intubation anesthesia plus intravenous anesthesia group (intubation group). They were compared and analyzed in terms of basic conditions, safety, and economy. Measurement data were analyzed by the t test or rank sum test, and count data were analyzed by the chi-square test.
RESULTS SpO2 was significantly lower in the non-intubation group compared with the intubation group (P < 0.05), and there were no significant differences in blood pressure, heart rate, or other vital signs between the two groups (P > 0.05). The intraoperative incidence of adverse reactions such as nausea, cough, hiccup, and snoring was significantly higher in the non-intubation group than in the intubation group, but these had little effect on the operation. The induction time, recovery time, and total operative time of the non-intubation group were significantly shorter than those of the intubation group (P < 0.01). There was no significant difference in endoscopic treatment time, endoscopic treatment cost, total hospitalization cost, or hospitalization days between the two groups (P > 0.05), but the anesthesia cost was higher in the intubation group than in the non-intubation group (P < 0.01).
CONCLUSION For patients with inactive bleeding undergoing endoscopic treatment for EGV, both tracheal intubation and non-tracheal intubation anesthesia can provide good anesthetic effects, and non-tracheal intubation anesthesia has shorter induction time, quicker recovery and lower anesthesia cost, representing a safe and economical anesthesia method.
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Affiliation(s)
- Lin Yu
- Department of Gastroenterology, First Affiliated Hospital of Shihezi University, Shihezi 832000, Xinjiang Uygur Autonomous Region, China
| | - Guo-Chen Shang
- Department of Gastroenterology, First Affiliated Hospital of Shihezi University, Shihezi 832000, Xinjiang Uygur Autonomous Region, China
| | - Li-Na Chen
- Department of Gastroenterology, First Affiliated Hospital of Shihezi University, Shihezi 832000, Xinjiang Uygur Autonomous Region, China
| | - Wei-Gang Chen
- Department of Gastroenterology, First Affiliated Hospital of Shihezi University, Shihezi 832000, Xinjiang Uygur Autonomous Region, China
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113
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Quénéhervé L, Dagouat C, Le Rhun M, Perez-Cuadrado Robles E, Duchalais E, Bruley des Varannes S, Touchefeu Y, Chapelle N, Coron E. Outcomes of first-line endoscopic management for patients with sigmoid volvulus. Dig Liver Dis 2019; 51:386-390. [PMID: 30377062 DOI: 10.1016/j.dld.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/27/2018] [Accepted: 10/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sigmoid volvulus is a common cause of colonic obstruction in old and frail patients. Its standard management includes the endoscopic detorsion of the colonic loop, followed by an elective sigmoidectomy to prevent recurrence. However, these patients are often poor candidates for surgery. AIM The aim of this study was to compare death rate between elective sigmoidectomy and conservative management following endoscopic detorsion for sigmoid volvulus. METHODS The medical records of 83 patients undergoing endoscopic detorsion of a sigmoid volvulus from 2008 to 2014 were retrospectively reviewed. Patients were divided into two groups: 'elective surgery' and 'no surgery'. RESULTS Patients in the 'no surgery' group (n = 42) were older and had more loss of autonomy than in the 'elective surgery' group. Volvulus endoscopic detorsion was successful in 96% of patients with no complications. The median follow-up was 13 months (1 day-67 months). The death rate was 62% in the 'no surgery' group versus 32% in the 'elective surgery' group (p = 0.02). In the 'no surgery' group, 23/42 of patients had volvulus recurrence. No recurrence occurred after surgery. CONCLUSION Elective surgery must be planned as soon as possible after the first episode of sigmoid volvulus. In frail patients, other options must be developed.
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Affiliation(s)
- Lucille Quénéhervé
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France.
| | - Caroline Dagouat
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Marianne Le Rhun
- Clinical Gerontology Department, University Hospital of Nantes, France
| | | | - Emilie Duchalais
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | | | - Yann Touchefeu
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Nicolas Chapelle
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
| | - Emmanuel Coron
- Institute of Digestive Diseases (IMAD), University Hospital of Nantes, Hôtel Dieu, Nantes, France
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Korpela T, Udd M, Lindström O, Kylänpää L. Fully covered self-expanding metal stents for benign refractory pancreatic duct strictures in chronic pancreatitis. Scand J Gastroenterol 2019; 54:365-370. [PMID: 30905221 DOI: 10.1080/00365521.2019.1588366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Pancreatic duct (PD) stricture is a common adverse event in chronic pancreatitis (CP). Primary treatment for refractory PD strictures is endotherapy (ET), including the insertion of multiple plastic stents. In addition, fully covered self-expandable metal stents (FC-SEMSs) have also been successfully used. More long-term studies are necessary to clarify the complication rate and efficiency, however. Methods: This retrospective study was comprised of 17 patients with symptomatic CP and refractory fibrotic main pancreatic duct (MPD) stricture treated with FC-SEMSs between 2010-2018 at the Helsinki University Hospital. Treated strictures were located in the pancreatic head. Technical success was defined as the accurate positioning of the stent and resolution of the MPD stricture. Clinical success was defined as pain relief at the end of the follow-up. Results: In 12 patients (71%), stricture resolution was accomplished. Clinical success was achieved in 12 patients (71%). The median duration of stenting was 169 days (range 15-804). Ten patients (58.8%) underwent a follow-up of two years or more. Early complications (≤7 days) occurred in two patients (12%): one pancreatitis and one cholestasis. Late complications (≥7 days) included severe abdominal pain (n = 2, 12%), pancreatitis (n = 3, 18%), cholestasis (n = 1, 6%) and stent migration (n = 7, 35%). Significant differences in stricture resolution and pain improvement were evident in patients with stent migration compared to patients without stent migration [1(14.3%) vs. 11(84.6%), p = .004 and 2(28.6%) vs. 11(84.6%), p = .022]. Conclusion: FC-SEMS placement is a safe and potentially effective treatment for this challenging group of patients. However, stent migration appears to affect the clinical and technical outcome.
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Affiliation(s)
- Taija Korpela
- a Department of Gastroenterological Surgery, Abdominal Center , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Marianne Udd
- a Department of Gastroenterological Surgery, Abdominal Center , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Outi Lindström
- a Department of Gastroenterological Surgery, Abdominal Center , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
| | - Leena Kylänpää
- a Department of Gastroenterological Surgery, Abdominal Center , Helsinki University Hospital and University of Helsinki , Helsinki , Finland
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Akand M, Buyukaslan A, Servi S, Civcik L. A hypothetical method for calculation of the access point, direction angle and access angle for percutaneous nephrolithotomy. Med Hypotheses 2019; 124:101-104. [PMID: 30798901 DOI: 10.1016/j.mehy.2019.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/01/2019] [Indexed: 12/23/2022]
Abstract
Urinary stone disease has an increasing prevalence across the globe, and endoscopic treatment modalities have replaced open surgery. Percutaneous nephrolithotomy (PCNL) is a successful, safe and reliable minimally invasive method in the treatment of renal stones, especially big (≥2 cm) or complex ones. Gaining access is the most critical step of this procedure, which can affect the rest of the operation. Although previously described techniques, eye of the needle and triangulation techniques, are being used for gaining access, urologists (especially novice ones) can still have problems during this step. Some navigation concepts have been developed in order to make the access safer, easier and more successful, however, none of them has been incorporated in daily routine practice till now because of either complicated techniques or requirement of sophisticated equipment. Our hypothesis is that the access point, direction angle and access angle in order to touch a stone during PCNL can be calculated by the data obtained from the computed tomography images with the help of mathematical formulations, namely the theorem of the cosine.
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Affiliation(s)
- Murat Akand
- Selcuk University, School of Medicine, Department of Urology, Konya, Turkey.
| | | | - Sema Servi
- Selcuk University, Faculty of Technology, Department of Computer Engineering, Program of Computer Software, Konya, Turkey
| | - Levent Civcik
- Selcuk University, Higher School of Vocational and Technical Sciences, Department of Computer Technologies, Konya, Turkey
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Dahlberg M, Nordberg M, Pieniowski E, Boström L, Sandblom G, Hallqvist-Everhov Å. Retained sex toys: an increasing and possibly preventable medical condition. Int J Colorectal Dis 2019; 34:181-183. [PMID: 30030606 PMCID: PMC6318238 DOI: 10.1007/s00384-018-3125-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Retained foreign rectal objects may require surgical removal. To estimate the magnitude of this problem, we report the incidence and treatment of retained rectal objects at a large emergency hospital, and calculate incidence rates at the national level in Sweden. METHODS All local patient records during 2009-2017 with the diagnosis foreign body in anus and rectum (ICD-10 T185) were accessed and analyzed retrospectively. All Swedish in- and outpatient visits during 2005-2016 with the code T185 were accessed from the National Patient Register. RESULTS We show an increasing incidence in rectal foreign bodies in Swedish national data. The increase was most noticeable in men, and in our local register there was an overrepresentation of sex toys leading to laparotomy and stoma. CONCLUSIONS To mitigate surgical cost and comorbidity, policies to decrease the risk of retained sex toys could be considered.
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Affiliation(s)
- Martin Dahlberg
- Department of Clinical Science and Education and Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm South General Hospital (Södersjukhuset), Sjukhusbacken 10, 118 83, Stockholm, Sweden.
| | - Martin Nordberg
- Department of Clinical Science and Education and Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm South General Hospital (Södersjukhuset), Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Emil Pieniowski
- Department of Clinical Science and Education and Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm South General Hospital (Södersjukhuset), Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Lennart Boström
- Department of Clinical Science and Education and Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm South General Hospital (Södersjukhuset), Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Gabriel Sandblom
- Department of Clinical Science and Education and Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm South General Hospital (Södersjukhuset), Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | - Åsa Hallqvist-Everhov
- Department of Clinical Science and Education and Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm South General Hospital (Södersjukhuset), Sjukhusbacken 10, 118 83, Stockholm, Sweden
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117
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March-Villalba JA, Marzullo-Zucchet L, Hervás-Marín D, Polo Rodrigo A, Serrano Durbá A, Domínguez Hinarejos C, Boronat Tormo F, Boronat Tormo F. [Clinical usefulness of the non-invasive functional study of the lower urinary tract voiding phase as a predictor of resolution after the first endoscopic treatment of vesico-ureteral reflux in children older than 3 years.]. ARCH ESP UROL 2019; 72:36-44. [PMID: 30741651] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the usefulnessof voiding diary (VD), uroflowmetry with electromyography(UF-EMG), bladder wall thickness (before micturition)(VWTUS) and residual urine (PVR) (ultrasound measure)in predicting the outcome of the first endoscopic treatment(1ENDT) of vesicoureteral reflux (VUR) in children> 3 years. METHODS Cross-sectional ambispective study of 48children with vesicoureteral reflux. Those with previousendoscopic treatment, age or neurological abnormalities and a history of urethralor abdominal surgery were excluded. The outcomevariable was the correctness (by isotopic cystography)three months after 1ENDT. Univariate and multivariateanalyses were performed through a Multilayer Perceptronnetwork and a logistic regression model EmpiricalBayesian penalized type LASSO Elastic net. Diagnosticaccuracy were determined. RESULTS Mean age of the sample was 6.8 +/- 2.28years. The rate of VUR correction after 1ENDT was 77%.The variables selected by both methods were: VD-retentionist(OR 3.90), high PVR (OR 2.69), high VWTUS (OR4.44). Normal UF-EMG was a preventive variable (OR0.38). Diagnostic accuracy (pSp=48.7%), UF+EMG (Se=27.3%(Se=72.7% (AUC=0.8 cut point 20 ml),VWTUS (Se=81.8% (AUC=0.8 cut point4.6 mm). There were no statistical differences betweenPVR and VWTUS. Combined use of UF+EMG+PVR(Se=90.9%in predicting the persistence of VUR after 1ENDT inchildren > 3 years. After screening with a VD, UF-EMG+ RPM combination could be useful to detect these patientsand propose a treatment that improves bladdervoiding function prior to surgery.
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Affiliation(s)
- José Antonio March-Villalba
- Sección de Urología Infantil. Servicio de Urología. Hospital Universitari i Politècnic La Fe. Valencia. España
| | - Leopoldo Marzullo-Zucchet
- Sección de Urología Infantil. Servicio de Urología. Hospital Universitari i Politècnic La Fe. Valencia. España
| | - David Hervás-Marín
- Unidad de Bioestadística. Instituto de Investigación Sanitaria Hospital Universitari i Politècnic La Fe. Valencia. España
| | - Alba Polo Rodrigo
- Sección de Urología Infantil. Servicio de Urología. Hospital Universitari i Politècnic La Fe. Valencia. España
| | - Agustín Serrano Durbá
- Sección de Urología Infantil. Servicio de Urología. Hospital Universitari i Politècnic La Fe. Valencia. España
| | - Carlos Domínguez Hinarejos
- Sección de Urología Infantil. Servicio de Urología. Hospital Universitari i Politècnic La Fe. Valencia. España
| | - Francisco Boronat Tormo
- Sección de Urología Infantil. Servicio de Urología. Hospital Universitari i Politècnic La Fe. Valencia. España
| | - Francisco Boronat Tormo
- Sección de Urología Infantil. Servicio de Urología. Hospital Universitari i Politècnic La Fe. Valencia. España
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Ishihara R, Goda K, Oyama T. Endoscopic diagnosis and treatment of esophageal adenocarcinoma: introduction of Japan Esophageal Society classification of Barrett's esophagus. J Gastroenterol 2019; 54:1-9. [PMID: 29961130 PMCID: PMC6314977 DOI: 10.1007/s00535-018-1491-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/27/2018] [Indexed: 02/04/2023]
Abstract
Endoscopic surveillance of Barrett's esophagus has become a foundation of the management of esophageal adenocarcinoma (EAC). Surveillance for Barrett's esophagus commonly involves periodic upper endoscopy with biopsies of suspicious areas and random four-quadrant biopsies. However, targeted biopsies using narrow-band imaging can detect more dysplastic areas and thus reduce the number of biopsies required. Several specific mucosal and vascular patterns characteristic of Barrett's esophagus have been described, but the proposed criteria are complex and diverse. Simpler classifications have recently been developed focusing on the differentiation between dysplasia and non-dysplasia. These include the Japan Esophageal Society classification, which defines regular and irregular patterns in terms of mucosal and vascular shapes. Cancer invasion depth is diagnosed by endoscopic ultrasonography (EUS); however, a meta-analysis of EUS staging of superficial EAC showed favorable pooled values for mucosal cancer staging, but unsatisfactory diagnostic results for EAC at the esophagogastric junction. Endoscopic resection has recently been suggested as a more accurate staging modality for superficial gastrointestinal cancers than EUS. Following endoscopic resection for gastrointestinal cancers, the risk of metastasis can be evaluated based on the histology of the resected specimen. European guidelines describe endoscopic resection as curative for well- or moderately differentiated mucosal cancers without lymphovascular invasion, and these criteria might be extended to lesions invading the submucosa (≤ 500 μm), i.e., to low-risk, well- or moderately differentiated tumors without lymphovascular involvement, and < 3 cm. These criteria were confirmed by a recent study in Japan.
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Affiliation(s)
- Ryu Ishihara
- grid.489169.bDepartment of Gastrointestinal Oncology, Osaka International Cancer Institute, 1-69 Otemae 3-chome, Chuo-ku, Osaka, 541-8567 Japan
| | - Kenichi Goda
- 0000 0000 8864 3422grid.410714.7Digestive Disease Centre, Showa University, Koto-Toyosu Hospital, Tokyo, Japan
| | - Tsuneo Oyama
- 0000 0000 8962 7491grid.416751.0Department of Endoscopy, Saku Central Hospital Advanced Care Center, Saku, Japan
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Ricard J, Quénéhervé L, Lefevre C, Le Rhun M, Chabrun E, Duchalais-Dassonneville E, Meurette G, Touchefeu Y, Bruley des Varannes S, Zerbib F, Coron E. Anterograde colonic irrigations by percutaneous endoscopic caecostomy in refractory colorectal functional disorders. Int J Colorectal Dis 2019; 34:169-75. [PMID: 30406317 DOI: 10.1007/s00384-018-3183-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE In case reports or small studies, percutaneous endoscopic caecostomy (PEC) has been proposed as an alternative to the Malone intervention to perform antegrade colonic enemas. Our goal was to assess the feasibility, efficacy, and tolerance of PEC in a large group of patients with refractory colorectal functional disorders. METHODS From September 2006 to April 2014, all patients undergoing PEC for constipation, fecal incontinence, and incontinence after rectal resection in two expert centers were studied. The PEC procedure consisted in anchoring the caecum to the abdominal wall (caecopexy) and placing a specifically designed tube in the colonic lumen to perform antegrade enemas. The quality of life (GIQLI), constipation (Kess), and incontinence (Cleveland) scores were assessed before PEC and at 3, 6, 12, and 24 months. RESULTS A total of 69 patients were included. GIQLI scores were significantly improved in constipation group (n = 43), incontinence group (n = 19), and rectal resection group (n = 10). In the constipation group, Kess score decreased from 25.9 before PEC to 20.6 at 2 years (p = 0.01). In the incontinence and post-rectal resection groups, Cleveland scores decreased from 14.3 before PEC to 2.7 at 6 months (p = 0.01) and to 10.4 at 2 years (p = 0.04). Overall, PEC was considered successful by patients in 58%, 74%, and 90% of cases, in constipation, incontinence, and rectal resection groups, respectively. Chronic pain (52%) at the catheter site was the most frequent complication. CONCLUSIONS Percutaneous endoscopic caecostomy for antegrade colonic enemas improves significantly the quality of life of patients with colorectal disorder refractory to medical treatment.
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Wang X, Kong DR. Endoscopic treatment of esophagogastric varices: Problems and thoughts. Shijie Huaren Xiaohua Zazhi 2018; 26:1959-1965. [DOI: 10.11569/wcjd.v26.i34.1959] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Esophagogastric variceal bleeding (EVB) is a common digestive emergency, and it is usually severe and is associated with a high mortality. The American Association of Liver Diseases guidelines recommend endoscopic treatment as the first choice for acute EVB. Studies have shown that emergency endoscopic hemostasis can achieve a success rate of > 90% and thus reduce the incidence of early rebleeding and the mortality rate of patients. Endoscopic treatment mainly includes endoscopic variceal ligation, endoscopic injection sclerotherapy, tissue adhesive injection, and endoscopic therapy combined with other treatments. However, the therapeutic effect of endoscopic treatment is related to the operator's skill, portal pressure, collateral circulation, esophageal varices, and other factors. Therefore, endoscopic treatment is not indicated for all cases. In addition, endoscopic treatment may cause serious complications. Here we describe the problems and thoughts on endoscopic treatment of esophagogastric varices.
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Affiliation(s)
- Xi Wang
- Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Hefei 237000, Anhui Province, China
| | - De-Run Kong
- Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University, Hefei 237000, Anhui Province, China
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Gan T, Wu JC, Yang JL. [Diagnosis and Minimally Invasive Endoscopic Treatment of Early Esophageal Cancer and Precancerous Lesions]. Sichuan Da Xue Xue Bao Yi Xue Ban 2018; 49:833-839. [PMID: 32677388] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Esophageal cancer is a common malignancy of digestive tract, and its prognosis is closely related to early diagnosis and treatment. In recent years, with the development of endoscopic diagnosis and treatment technology, especially the breakthrough progress of new endoscopic equipments, the detection rate of early esophageal cancer and precancerous lesions is significantly improved, and more and more patients with early esophageal cancer can be treated with minimally invasive endoscopic treatment. At present, endoscopic dissection has become the preferred treatment for early esophageal cancer and precancerous lesions. The advantages is not only less traumatic than traditional surgery, but also retain the physiological structure of esophagus, achieve accurate postoperative pathology and better postoperative quality of life of patients. However, endoscopic minimally invasive treatment in progress also face new problems to be solved, such as how to deal with multifocal esophageal lesions, how to estimate esophageal lesions infiltration depth and lymph node metastasis risk accurately, how to understand the discrepancy between biopsy and postoperative pathology, how to deal with the positive resection margins as well as intraoperative and postoperative complications, how to manage endoscopic treatment of the special subpopulation of the patients, whether and when additional radical surgery should be provided to the patients with non-curative endoscopic treatment, and so on. Aiming to the above problems and the purpose to improve the prognosis and the quality of life of esophageal cancer patients, this topic includes a series studies to explore standardized treatment scheme and management strategy for postoperative complications in the endoscopic treatment of early esophageal cancer and precancerious lesions.
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Affiliation(s)
- Tao Gan
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jun-Chao Wu
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jin-Lin Yang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China
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Teklali Y, Robert Y, Boillot B, Overs C, Piolat C, Rabattu PY. Endoscopic management of primary obstructive megaureter in pediatrics. J Pediatr Urol 2018; 14:382-387. [PMID: 30006257 DOI: 10.1016/j.jpurol.2018.05.027] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 05/23/2018] [Indexed: 10/28/2022]
Abstract
AIMS The aims of this study were to evaluate the efficacy and safety of endoscopic treatment of primary obstructive megaureter in children, and to assess its long-term outcome. METHODS Case files of 35 children who had endoscopic treatment of symptomatic primary obstructive megaureter between 2006 and 2016 were retrospectively analyzed. All children had ureterovesical junction dilatation with one or more ureteral dilators, and insertion of a JJ stent. An analysis of the case files and a comparison between pre- and postoperative ultrasound and scintigraphy findings were performed. RESULTS The study population consisted of 22 boys and 13 girls aged between 2 months and 16 years. The follow-up period ranged from 8 months to 10 years. Twenty-one children (60%) were under 2 years at the time of treatment. The average duration of JJ stenting was 7 weeks (3-16 weeks). Thirty-four of 35 children (97%) were considered definitively cured, that is, asymptomatic with preserved renal function. Two children required open surgery for a failed endoscopic treatment procedure. Secondary reimplantation surgery was only necessary in one case (1/35) after technically satisfactory endoscopic treatment. Twelve of 35 children had a complication, including two Clavien III complications. Comparison of pre- and postoperative ultrasonography showed a significant decrease in ureteral diameter in 31 cases. Postoperative scintigraphy showed a significant improvement in the ureteral leaking curve in 20 children. CONCLUSION In our experience, endoscopic treatment of congenital obstructive megaureter in pediatrics seems to be safe and effective. It is proposed as a first-line treatment for children requiring an intervention, even for young children under 2 years.
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Affiliation(s)
- Youssef Teklali
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France.
| | - Yohann Robert
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France
| | - Bernard Boillot
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France; Department of Urology, University Hospital of Grenoble, Grenoble, France
| | - Camille Overs
- Department of Urology, University Hospital of Grenoble, Grenoble, France
| | - Christian Piolat
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France
| | - Pierre Yves Rabattu
- Department of Pediatric Surgery, Children's Hospital, University Hospital of Grenoble, Grenoble, France
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Temiz A, Ezer SS, Gedikoğlu M, Serin E, İnce E, Gezer HÖ, Canan MO, Hiçsönmez A. Management of traumatic bile duct injuries in children. Pediatr Surg Int 2018; 34:829-836. [PMID: 29948144 DOI: 10.1007/s00383-018-4295-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Pediatric experience with biliary tract injuries (BTI) is limited and mostly consists of case presentations. The purpose of this study is to evaluate clinical and radiological findings of possible BTI, treatment strategies, and results. METHODS The records of nine patients with the diagnosis of BTI between July 2009 and November 2017 were reviewed retrospectively. RESULTS There were seven boys and two girls (mean 8.05 ± 4.39 years). The mechanisms were motor vehicle occupant, fall, crush and gunshot wound. Hepatic laceration routes that extended into the porta hepatis and contracted the gall bladder were demonstrated on computerized tomography (CT). Bile duct injury was diagnosed with bile leakage from the thoracic tube (n = 2), from the abdominal drain (n = 2) and by paracentesis (n = 5). Extrahepatic (n = 8) and intrahepatic (n = 1) bile duct injuries were diagnosed by cholangiography. Endoscopic retrograde cholangiography, sphincterotomy, and stent placement were successfully completed in five patients. Peritoneal drainage stopped after 3-17 days of procedure in four patients. The fifth patient was operated with the diagnosis of cystic duct avulsion. Cholecystectomies, primary repair of laceration, cystic duct ligation, and Roux-en-Y hepatoportoenterostomy were performed in the remaining four patients. All patients presented with clinically normal findings, normal liver functions, and normal ultrasonographic findings in the follow-up period. CONCLUSIONS The presentation of the parenchymal injury extending to the porta hepatis with contracted gall bladder on CT and diffuse homogenous abdominal fluid should be considered as signs of BTI. We suggest a multi-disciplinary approach for the diagnosis and treatment of BTIs. Surgery may be indicated according to the patient's clinical condition, radiological findings and failure of non-operative treatment.
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Affiliation(s)
- Abdulkerim Temiz
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Dadaloğlu mah. 39 sokak, No: 6, Yüreğir, 01250, Adana, Turkey.
| | - Semire Serin Ezer
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Dadaloğlu mah. 39 sokak, No: 6, Yüreğir, 01250, Adana, Turkey
| | - Murat Gedikoğlu
- Department of Radiology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Adana, Turkey
| | - Ender Serin
- Department of Gastroenterology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Adana, Turkey
| | - Emine İnce
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Dadaloğlu mah. 39 sokak, No: 6, Yüreğir, 01250, Adana, Turkey
| | - Hasan Özkan Gezer
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Dadaloğlu mah. 39 sokak, No: 6, Yüreğir, 01250, Adana, Turkey
| | - Mehmet Oğuz Canan
- Department of Pediatric Gastroenterology, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Adana, Turkey
| | - Akgün Hiçsönmez
- Department of Pediatric Surgery, Başkent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Educational Hospital, Dadaloğlu mah. 39 sokak, No: 6, Yüreğir, 01250, Adana, Turkey
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Abstract
Dieulafoy's lesion, also named calibre persistent submucosal artery, is one of the rare and fatal causes of gastrointestinal bleeding, which can occur throughout the digestive tract. About 4% of Dieulafoy's lesions are located in the colon and rectum, especially in the rectum, cecum, and ascending colon. At present, the etiology and pathogenesis of colorectal Dieulafoy's disease are still not completely clear. The main clinical manifestation of colorectal Dieulafoy's disease is recurrent and massive hematochezia, and there may be no clinical manifestation during the intermittent period of the hemorrhage. The diagnosis and treatment of Dieulafoy's disease mainly rely on endoscopy, but due to the operating difficulties, clinical characteristics, and other factors, the treatment and diagnosis of this disease remain a challenge to clinicians. In this paper, we will discuss the pathology, etiology, pathogenesis, pathology, diagnosis, and treatment of colorectal Dieulafoy's lesion.
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Affiliation(s)
- Huan-Yu Liu
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Lin Sun
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Yu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Ling-Yun Xv
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Ning-Ning Chen
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
| | - Ying-Chao Li
- Department of Gastroenterology, The First Affiliated Hospital of Xian Jiaotong University, Xi'an 710061, Shaanxi Province, China
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Valli PV, Mertens JC, Sonnenberg A, Bauerfeind P. Nonampullary Duodenal Adenomas Rarely Recur after Complete Endoscopic Resection: A Swiss Experience Including a Literature Review. Digestion 2018; 96:149-157. [PMID: 28854423 DOI: 10.1159/000479625] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/17/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Duodenal polyps and especially duodenal adenomas are a rare and mostly coincidental finding in patients undergoing upper gastrointestinal endoscopy. Due to their malignant potential, duodenal adenomas should be removed upon diagnosis. So far, the limited available data on the performance of endoscopic polypectomy show conflicting results with regard to adverse events and the adenoma recurrence rate. PATIENTS AND METHODS After summarizing the currently available data, we retrospectively analyzed all patients undergoing endoscopic resection of nonampullary duodenal adenomas (NAD) at our institution between 2006 and 2016. RESULTS A total of 78 patients underwent endoscopic polypectomy for NAD adenoma. End-of-treatment success with complete resection requiring a mean of 1.2 interventions was achieved in 91% (n = 71). Procedural hemorrhage occurred in 12.8% (n = 10), whereas delayed bleeding was noted in 9% (n = 7). Duodenal perforation was registered and successfully treated in 2 cases (2.6%). No adenoma recurrence was noted following primary complete adenoma resection after a mean follow-up time of 33 months. Acute post-polypectomy bleeding was statistically significantly associated with large polyp size (p = 0.003) and lack of endoscopic prophylaxis (p = 0.0008). Delayed post-polypectomy bleeding showed a trend in the occurrence of large polyps (p = 0.064), and was statistically significantly associated with familial cancer syndrome (p = 0.019) and advanced histopathology (p = 0.013). CONCLUSION Our data suggest that endoscopic polypectomy of NAD is well feasible with high success rates. Procedural and delayed hemorrhage seems to be the primary issue rather than adenoma recurrence. We therefore advocate referral of patients with large NAD to experienced centers for endoscopic resection.
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Affiliation(s)
- Piero V Valli
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
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Mizumoto T, Hiyama T, Oka S, Yorita N, Kuroki K, Kurihara M, Yoshifuku Y, Sanomura Y, Urabe Y, Murakami Y, Arihiro K, Tanaka S, Chayama K. Curative Criteria After Endoscopic Resection for Superficial Esophageal Squamous Cell Carcinomas. Dig Dis Sci 2018; 63:1605-1612. [PMID: 29564670 DOI: 10.1007/s10620-018-5029-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 03/15/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND According to the Japanese Esophageal Society (JES) guidelines, risk factors for lymph node (LN) metastasis in the muscularis mucosa (MM)/submucosa to a depth of up to 200 μm (SM1) in cases of esophageal squamous cell carcinomas (ESCCs) include the presence of lymphatic invasion (ly), venous invasion (v), infiltration pattern (INF)c, and SM1. The long-term prognoses of these patients are unclear, and there are very few reports on the validation of the curative criteria for MM/SM1 ESCCs. AIMS To examine the long-term prognoses of these patients and the risk factors for LN metastasis of MM/SM1 ESCCs after endoscopic resection (ER). METHODS This study included patients with MM/SM1 ESCCs who underwent ER at Hiroshima University Hospital from December 1990 to November 2016. We evaluated the clinicopathological characteristics of 98 patients and overall survival, disease-specific survival, recurrence-free survival, and recurrence rates in the e-curative and non-e-curative groups. RESULTS The mean observation period was 75 months. There was no significant difference in disease-specific survival rate between the e-curative and non-e-curative groups (100 vs. 98%). There was no significant difference in disease-specific survival rates between the groups (100 vs. 98%). In contrast, the LN recurrence-free survival rate in patients with INFa, ly(-), and v(-) was significantly higher than that in patients with INFb/c, ly(+), or v(+) (100 and 87%, P < 0.05). CONCLUSION Contrary to the JES guidelines, our findings suggest that new criteria (MM/SM1, INFa, negative vertical margin (VM0), ly[-], and v[-]) may be associated with curative ER without additional treatment.
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Affiliation(s)
- T Mizumoto
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - T Hiyama
- Health Service Center, Hiroshima University, 1-7-1 Kagamiyama, Higashihiroshima, 739-8514, Japan.
| | - S Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - N Yorita
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - K Kuroki
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - M Kurihara
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Y Yoshifuku
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Y Sanomura
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Y Urabe
- Department of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Y Murakami
- Department of Radiation Oncology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - K Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - S Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - K Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
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Sei H, Tomita T, Nakai K, Nakamura K, Tamura A, Ohda Y, Oshima T, Fukui H, Watari J, Miwa H. Rectal Foreign Body of Eggplant Treated Successfully by Endoscopic Transanal Removal. Case Rep Gastroenterol 2018; 12:189-193. [PMID: 29805365 PMCID: PMC5968260 DOI: 10.1159/000488974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/03/2018] [Indexed: 11/19/2022] Open
Abstract
Transanal rectal foreign body implies that a foreign body has been inserted transanally due to sexual orientation or other reasons and cannot be removed. Such cases require emergency measures because foreign bodies often present difficulties in manual removal or endoscopic removal and may even require surgery when peritonitis due to gastrointestinal perforation occurs. We report a patient in our hospital who had a rectal foreign body inserted into the deep part of the proctosigmoid that could be removed endoscopically. A 66-year-old man visited our hospital because of an eggplant which had been inserted into his rectum by his friend and could not be removed. Since plain abdominal computed tomography showed a foreign body thought to be an eggplant in the proctosigmoid, the foreign body was captured and removed with a snare under lower gastrointestinal endoscope guidance.
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Affiliation(s)
- Hiroo Sei
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Keisuke Nakai
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kumiko Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Akio Tamura
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yoshio Ohda
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Jiro Watari
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Martín Arranz E, Martín Arranz MD, Robredo T, Mancheño-Corvo P, Menta R, Alves FJ, Suárez de Parga JM, Mora Sanz P, de la Rosa O, Büscher D, Lombardo E, de Miguel F. Endoscopic submucosal injection of adipose-derived mesenchymal stem cells ameliorates TNBS-induced colitis in rats and prevents stenosis. Stem Cell Res Ther 2018; 9:95. [PMID: 29631607 PMCID: PMC5892014 DOI: 10.1186/s13287-018-0837-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/09/2018] [Accepted: 03/13/2018] [Indexed: 02/07/2023] Open
Abstract
Background Mesenchymal stem cells have potential applications in inflammatory bowel disease due to their immunomodulatory properties. Our aim was to evaluate the feasibility, safety and efficacy of endoscopic administration of adipose-derived mesenchymal stem cells (ASCs) in a colitis model in rats. Methods Colitis was induced in rats by rectal trinitrobenzenesulfonic acid (TNBS). After 24 h ASCs (107 cells) or saline vehicle were endoscopically injected into the distal colon. Rats were followed for 11 days. Daily weight, endoscopic score at days 1 and 11, macroscopic appearance at necropsy, colon length and mRNA expression of Foxp3 and IL-10 in mesenteric lymph nodes (MLN) were analyzed. Results Endoscopic injection was successful in all the animals. No significant adverse events or mortality due to the procedure occurred. Weight evolution was significantly better in the ASC group, recovering initial weight by day 11 (− 0.8% ± 10.1%, mean ± SD), whereas the vehicle group remained in weight loss (− 6.7% ± 9.2%, p = 0.024). The endoscopic score improved in the ASC group by 47.1% ± 5.3% vs. 21.8% ± 6.6% in the vehicle group (p < 0.01). Stenosis was less frequent in the ASC group (4.8% vs. 41.2%, p < 0.01). Colon length significantly recovered in the ASC group versus the vehicle group (222.6 ± 17.3 mm vs. 193.6 ± 17.9 mm, p < 0.001). The endoscopic score significantly correlated with weight change, macroscopic necropsy score and colon length. Foxp3 and IL-10 mRNA levels in MLN recovered with ASC treatment. Conclusions ASC submucosal endoscopic injection is feasible, safe and ameliorates TNBS-induced colitis in rats, especially stenosis. Electronic supplementary material The online version of this article (10.1186/s13287-018-0837-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eduardo Martín Arranz
- Gastroenterology Department, La Paz University Hospital, Paseo de la Castellana 261 4th floor, 28046, Madrid, Spain.
| | - María Dolores Martín Arranz
- Gastroenterology Department, La Paz University Hospital, Paseo de la Castellana 261 4th floor, 28046, Madrid, Spain
| | - Tomás Robredo
- Cell Therapy Laboratory, La Paz Hospital Institute for Health Research, Madrid, Spain
| | | | | | | | - Jose Manuel Suárez de Parga
- Gastroenterology Department, La Paz University Hospital, Paseo de la Castellana 261 4th floor, 28046, Madrid, Spain
| | - Pedro Mora Sanz
- Gastroenterology Department, La Paz University Hospital, Paseo de la Castellana 261 4th floor, 28046, Madrid, Spain
| | | | - Dirk Büscher
- Grifols SA, Sant Cugat del Vallés, Barcelona, Spain
| | | | - Fernando de Miguel
- Cell Therapy Laboratory, La Paz Hospital Institute for Health Research, Madrid, Spain
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Chantarojanasiri T, Isayama H, Nakai Y, Matsubara S, Yamamoto N, Takahara N, Mizuno S, Hamada T, Kogure H, Koike K. Groove Pancreatitis: Endoscopic Treatment via the Minor Papilla and Duct of Santorini Morphology. Gut Liver 2018; 12:208-213. [PMID: 29212312 PMCID: PMC5832346 DOI: 10.5009/gnl17170] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/14/2017] [Accepted: 06/26/2017] [Indexed: 01/16/2023] Open
Abstract
Background/Aims Groove pancreatitis (GP) is an uncommon disease involving the pancreaticoduodenal area. Possible pathogenesis includes obstructive pancreatitis in the duct of Santorini and impaired communication with the duct of Wirsung, minor papilla stenosis, and leakage causing inflammation. Limited data regarding endoscopic treatment have been published. Methods Seven patients with GP receiving endoscopic treatment were reviewed. The morphology of the pancreatic duct was evaluated by a pancreatogram. Endoscopic dilation of the minor papilla and drainage of the duct of Santorini were performed. Results There were two pancreatic divisum cases, one ansa pancreatica case and four impaired connections between the duct of Santorini and the main pancreatic duct. Three to 31 sessions of endoscopy, with 2 to 24 sessions of transpapillary stenting and dilation, were performed. Interventions through the minor papilla were successfully performed in six of seven cases. The pancreatic stenting duration ranged from 2 to 87 months. Five patients with evidence of chronic pancreatitis (CP) tended to receive more endoscopic interventions than did the two patients without CP (2–24 vs 2, respectively) for GP and other complications associated with CP. Conclusions Disconnection or impairment of communication between the ducts of Santorini and Wirsung was observed in all cases of GP. No surgery was required, and endoscopic minor papilla dilation and drainage of the duct of Santorini were feasible for the treatment of GP.
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Affiliation(s)
- Tanyaporn Chantarojanasiri
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Internal Medicine, Police General Hospital, Bangkok, Thailand
| | - Hiroyuki Isayama
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Nakai
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Saburo Matsubara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Natsuyo Yamamoto
- Department of Gastroenterology, Toshiba General Hospital, Tokyo, Japan
| | - Naminatsu Takahara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Suguru Mizuno
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Hirofumi Kogure
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Fusaro F, Tambucci R, Romeo E, Bagolan P, Dall'Oglio L, Ceccarelli S, Francalanci P, Hermans D, Pietrobattista A, Diamanti A, Torroni F, De Angelis P. Anastomotic ulcers in short bowel syndrome: New suggestions from a multidisciplinary approach. J Pediatr Surg 2018; 53:483-488. [PMID: 28610705 DOI: 10.1016/j.jpedsurg.2017.05.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Anastomotic ulceration (AU) is a rare potential life-threatening complication that may occur after intestinal resection. The diagnosis is often delayed after a long-lasting history of refractory anemia. The pathogenesis remains unknown and there are no established therapies. The aim of the study was to analyze the medical history of children with short bowel syndrome (SBS) who were experiencing AU. METHODS Records of SBS children were retrospectively reviewed. Demographics, baseline characteristics, presentation, diagnosis and treatment of AU cases were analyzed. RESULTS Eight out of 114 children with SBS were identified as having AU. Mean gestational age was 32.5weeks. Underlying diseases were: 5 necrotising enterocolitis, 2 gastroschisis and 1 multiple intestinal atresia. The mean age at AU diagnosis was 6.5years (diagnosis delay of 35months). All but 2 patients had AU persistency after medical treatment. Endoscopic treatment (2 argon plasma coagulation; 1 platelet-rich fibrin instillation; 2 endoscopic hydrostatic dilations) was effective in 3 out of 5 children. Surgery was required in 3 patients. CONCLUSIONS Severe bowel ischemic injury, especially in preterm infant, could predispose to AU development. Medical treatment showed discouraging results. We firstly described that different endoscopic treatment could be attempted before resorting to further surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Fabio Fusaro
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy.
| | - Renato Tambucci
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy; Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Erminia Romeo
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy
| | - Pietro Bagolan
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy
| | - Luigi Dall'Oglio
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy
| | - Stefano Ceccarelli
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paola Francalanci
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy
| | - Dominique Hermans
- Department of Pediatrics, Saint Luc Hospital - Université Catholique De Louvain, Brussels, Belgium
| | - Andrea Pietrobattista
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Diamanti
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy
| | - Filippo Torroni
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy
| | - Paola De Angelis
- Intestinal Failure Rehabilitation Group, Bambino Gesù Children's Hospital, Rome, Italy
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Zeng Y, Liang W, Liu J, He J. Endoscopic Treatment Versus Esophagectomy for Early-Stage Esophageal Cancer: a Population-Based Study Using Propensity Score Matching. J Gastrointest Surg 2017; 21:1977-1983. [PMID: 29030780 DOI: 10.1007/s11605-017-3563-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/24/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Endoscopic treatment (ET) is an alternative for selected patients with early-stage esophageal cancer. The primary aim of this study was to compare overall survival (OS) and esophageal cancer-specific survival (ECSS) of such patients after ET or esophagectomy. METHODS Propensity score matching (PSM) and Cox regression analysis were used to compare OS and ECSS of 2661 patients with ET or esophagectomy for early-stage (Tis-T1N0M0) disease. Patient information was retrieved from the Surveillance, Epidemiology, and End Results database. Subgroup analyses by T stage and tumor histology were also performed. RESULTS There were significant differences in age, sex ratio, year of diagnosis, cancer site, cancer stage, differentiation grade, tumor histology, tumor size, lymph nodes examined, and receipt of radiation therapy in the two treatment groups. PSM created 621 patient pairs. Multivariate analysis found no significant differences in OS (HR = 1.216, P = 0.279) or ECSS (HR = 0.692, P = 0.179) in the esophagectomy and ET groups. The results were similar for subgroup analyses limited to stage Tis, T1a, and T1b patients. ET was also associated with similar OS and ECSS in esophageal adenocarcinoma and squamous cell carcinoma patients. CONCLUSION In this population-based study using PSM, patients with stage Tis and T1N0M0 esophageal cancer with ET had OS and ECSS comparable to those treated by esophagectomy after adjusting for clinical variables. The results support ET as an alternative to esophagectomy in early esophageal cancer.
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Affiliation(s)
- Yuan Zeng
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People's Republic of China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Wenhua Liang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People's Republic of China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jun Liu
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People's Republic of China.,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, No 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, People's Republic of China. .,Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou, China.
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132
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Zambaiti E, Sergio M, Casuccio A, Salerno S, Cimador M. Intraoperative ultrasound-assisted approach for endoscopic treatment of vesicoureteral reflux in children. J Pediatr Surg 2017; 52:1661-1665. [PMID: 28442139 DOI: 10.1016/j.jpedsurg.2017.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/06/2017] [Accepted: 04/09/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Despite minimal invasiveness and high success rate, guidelines still prescribe voiding Cystourethrogram (VCUG) after endoscopic treatment for vesicoureteral reflux (VUR) in children. The aim of this paper was to analyze whether intraoperative ultrasound (IO-US) could improve surgical accuracy and perioperative counseling, thus potentially decreasing the need for postoperative VCUG. METHODS We selected children treated for moderate to high grade VUR, renal scarring or repeated infections under antibiotic prophylaxis from January to December 2015. Endoscopic injection was combined with IO-US to detect optimal needle placement and to guide mound formation. IO-US findings were compared to surgeon opinion and postoperative VCUG, performed 3months after surgery. All patients were followed-up for 1year. RESULTS A significant relationship was found between IO-US mound height (p=0.003) or localization (p<0.0005) and VCUG. Success of endoscopic treatment vs persistence of reflux groups had a mean mound height of 10.62±1.36mm and 8.39±1.08mm respectively (p<0.0005). Height maintained a significant correlation with success in simple and multivariable regression analysis. ROC curve determined ≥9.8mm as predictor of reflux resolution (95% CI 0.825 to 0.998; p<0.0001). CONCLUSIONS IO-US facilitates pediatric urologists to find an optimal location, to reach a volcano mound morphology and height, thus increasing intraoperative accuracy. IO-US also helps evaluating high-risk recurrence and guiding prognostic counseling. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Elisa Zambaiti
- Pediatric Urological Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127 Palermo, Italy.
| | - Maria Sergio
- Pediatric Urological Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127 Palermo, Italy
| | - Alessandra Casuccio
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 133, 90133 Palermo, Italy
| | - Sergio Salerno
- Section of Radiological Sciences, Department of Radiology, AOU Policlinico Paolo Giaccone, Via del Vespro 127, 90127 Palermo, Italy
| | - Marcello Cimador
- Pediatric Urological Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", AOU Policlinico Paolo Giaccone, Via Giordano 3, 90127 Palermo, Italy
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133
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Huh CW, Kim BW. [ Endoscopic Treatment of Gastric Adenoma]. Korean J Gastroenterol 2017; 70:115-120. [PMID: 28934826 DOI: 10.4166/kjg.2017.70.3.115] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Gastric adenoma (dysplasia) is a precancerous lesion. Therefore, managements of gastric adenomas are important for preventing the development of gastric cancers and for detecting gastric cancers at earlier stages. The Vienna classification divides gastric adenomas into two categories: high-grade dysplasia and low-grade dysplasia. Generally, endoscopic resection is performed for adenoma with high-grade dysplasia due to the coexistence of carcinoma and the potential of progression to carcinomas. However, the treatments of adenoma with low-grade dysplasia remain controversial. Currently two treatment strategies for the low-grade type have been suggested; First is the 'wait and see' strategy; Second is endoscopic treatment (e.g., endoscopic mucosal resection, endoscopic submucosal dissection, or argon plasma coagulation). In this review, we discuss the current optimal strategies for endoscopic management of gastric adenoma.
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Affiliation(s)
- Cheal Wung Huh
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Byung Wook Kim
- Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Abstract
Introduction Cholelithiasis usually can be managed successfully by endoscopic sphincterotomy. Choledochoduodenostomy (CDD) is one of the surgical treatment options but its acceptance remains debated because of the risk of reflux cholangitis and sump syndrome. The aim of this study was to assess the current features and outcomes of patient undergoing CDD. Patients and methods We retrospectively analysed the surgical results of consecutive 130 patients treated by CDD between 1991 and 2013 and excluded five cases with a malignant disorder. Indications for surgery included endoscopic management where stones were difficult or failed to pass and primary common bile duct stones with choledochal dilatation. Incidences of reflux cholangitis, stone recurrence, pancreatitis or sump syndrome were investigated and the data between end-to-side and side-to-side CDD were compared. Results Reflux cholangitis and stone recurrence was 1.6% (2/125) and 0% (0/125) of cases by CDD. There is no therapeutic-related pancreatitis in CDD. Sump syndrome was not also observed in side-to-side CDD. Conclusions This study is a first comparative study between end-to-side and side-to-side CDD. The surgical outcomes for CDD treatment of choledocholithiasis were acceptable. The incidence of reflux cholangitis, stone recurrence, pancreatitis and sump syndrome was very low.
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Affiliation(s)
- H Okamoto
- Department of Gastrointestinal, Breast and Endocrine Surgery, Faculty of Medicine, University of Yamanashi , Yamanashi , Japan
- Department of Surgery, Tsuru Municipal Hospital , Yamanashi , Japan
| | - K Miura
- Department of Gastrointestinal, Breast and Endocrine Surgery, Faculty of Medicine, University of Yamanashi , Yamanashi , Japan
| | - J Itakura
- Department of Gastrointestinal, Breast and Endocrine Surgery, Faculty of Medicine, University of Yamanashi , Yamanashi , Japan
| | - H Fujii
- Department of Gastrointestinal, Breast and Endocrine Surgery, Faculty of Medicine, University of Yamanashi , Yamanashi , Japan
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Soh JS, Lim H, Kang HS, Kim JH, Kim KC. Does the discrepancy in histologic differentiation between a forceps biopsy and an endoscopic specimen necessitate additional surgery in early gastric cancer? World J Gastrointest Oncol 2017; 9:319-326. [PMID: 28868112 PMCID: PMC5561043 DOI: 10.4251/wjgo.v9.i8.319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/09/2017] [Accepted: 06/07/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the clinicopathological variables in early gastric cancer (EGC) patients in relation to differentiation discrepancy.
METHODS The data of 265 specimens from 240 patients with EGC, who had undergone radical operation at Hallym University Sacred Heart Hospital from 2010 to 2015, were retrospectively analyzed. We evaluated clinical, endoscopic, and histopathological data according to histological discrepancy.
RESULTS Clinically significant discrepancy rate showed the difference in differentiated type (well and moderately differentiated) and undifferentiated type (poorly differentiated and signet ring cell) between endoscopic biopsies and postoperative specimens was 9.4% (25/265). There were no differences in tumor location, size, gross pattern, and number of biopsies. Specimens having histological discrepancy showed more submucosal invasion (72.0% vs 49.6%, P = 0.033) and lymph node involvement (24.0% vs 7.9%, P = 0.009) than specimens having non-discrepancy. The rate of a positive epidermal growth factor receptor status was higher in specimens having discrepancy than in specimens having non-discrepancy (81.0% vs 55.4%, P = 0.035).
CONCLUSION The discordance of histologic differentiation is associated with higher submucosal invasion and lymph node metastases in EGC. Patients have histological discrepancy may require additional surgical treatments.
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Chapuis-Roux E, Pellissier L, Browet F, Berthou JC, Hakim S, Brazier F, Cosse C, Delcenserie R, Regimbeau JM. How can recovery be enhanced after single-stage laparoscopic management of CBD stones? Endoscopic treatment versus laparoscopic surgery. Dig Liver Dis 2017; 49:773-9. [PMID: 28389089 DOI: 10.1016/j.dld.2017.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/16/2017] [Accepted: 02/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Single-stage management of CBD stones comprises simultaneous common bile duct (CBD) clearance and cholecystectomy. The CBD can be cleared by using endoscopic treatment (ET) or laparoscopic surgery (LS) alone. AIMS To determine the most rapid recovery after the single-stage laparoscopic management of CBD stones. METHODS Patients with CBD stones treated at either of two centers (one performing ET only and one performing LS only for single-stage treatment) were included. The primary endpoint was "the textbook outcome". RESULTS The feasibility rate was 74% for ET and 100% for LS (p≤0.001). The proportion of cases with the textbook outcome was higher in the ET group than in the LS-only group (73% vs. 10%; p<0.001). The CBD clearance rate was similar in the ET and LS-only groups (100% vs. 96.6%, respectively; p=0.17). The overall morbidity rate was lower in the ET group than in the LS-only group (23% vs. 29%, p=0.05). CONCLUSION AND RELEVANCE Both ET and LS are feasible, safe and effective for clearance of the CBD. ET was better than LS in terms of a less frequent requirement for drainage and a shorter length of hospital stay. LS was associated with a shorter operating time.
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137
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Ugenti I, Travaglio E, Lagouvardou E, Caputi Iambrenghi O, Martines G. Successful endoscopic treatment of gastric phytobezoar: A case report. Int J Surg Case Rep 2017; 37:45-47. [PMID: 28633127 PMCID: PMC5479946 DOI: 10.1016/j.ijscr.2017.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/08/2017] [Accepted: 06/11/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Gastric bezoars are a rare condition associated with situations of gastric dysmotility and prior gastric surgery, though sometimes they can present without any risk factor. We describe the first successful treatment in medical literature of a large gastric bezoar in the outpatient setting through endoscopic fragmentation. CASE PRESENTATION A 76-year-old man was referred to our outpatient endoscopy clinic because of dyspepsia and epigastric pain. Upper GI endoscopy with a standard endoscope revealed a 10-cm-diameter gastric phytobezoar with necrotic pressure ulcer of the angulus. We fragmentized the bezoar into smaller pieces, with complete dissolution and without any complication. The patient was then promptly discharged home with a medical therapy. Follow-up endoscopy at 6 months showed the total disappearance of any residual fibers. DISCUSSION Different types of bezoars are described in literature, of which phyto- and trychobezoars are the most frequent. They can be absolutely asymptomatic or can arise with epigastric pain, pressure ulcer bleeding, gastrointestinal perforation or small bowel obstruction. The treatment is debated though endoscopic removal or fragmentation with the help of Coca-Cola lavages has showed the best success rate. The main experiences in literature concern hospitalized patients or describe treatment techniques which require overnight stays. An effective and rapid treatment in the outpatient setting is described in our experience, without short- or long-term complications. CONCLUSION The endoscopic fragmentation of large gastric bezoars in the outpatient setting is safe with a good clinical course.
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Affiliation(s)
- Ippazio Ugenti
- Dept of Emergency and Organ Trasplantation, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.
| | - Elisabetta Travaglio
- Dept of Emergency and Organ Trasplantation, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.
| | - Elpiniki Lagouvardou
- Dept of Emergency and Organ Trasplantation, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.
| | - Onofrio Caputi Iambrenghi
- Dept of Emergency and Organ Trasplantation, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.
| | - Gennaro Martines
- Dept of Emergency and Organ Trasplantation, University of Bari, Piazza G. Cesare, 11, 70124 Bari, Italy.
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Stigliano S, Sternby H, de Madaria E, Capurso G, Petrov MS. Early management of acute pancreatitis: A review of the best evidence. Dig Liver Dis 2017; 49:585-94. [PMID: 28262458 DOI: 10.1016/j.dld.2017.01.168] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 12/11/2022]
Abstract
In the 20th century early management of acute pancreatitis often included surgical intervention, despite overwhelming mortality. The emergence of high-quality evidence (randomized controlled trials and meta-analyses) over the past two decades has notably shifted the treatment paradigm towards predominantly non-surgical management early in the course of acute pancreatitis. The present evidence-based review focuses on contemporary aspects of early management (which include analgesia, fluid resuscitation, antibiotics, nutrition, and endoscopic retrograde cholangiopancreatography) with a view to providing clear and succinct guidelines on early management of patients with acute pancreatitis in 2017 and beyond.
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139
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Roos FJM, Poley JW, Polak WG, Metselaar HJ. Biliary complications after liver transplantation; recent developments in etiology, diagnosis and endoscopic treatment. Best Pract Res Clin Gastroenterol 2017. [PMID: 28624111 DOI: 10.1016/j.bpg.2017.04.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biliary complications are considered to be the Achilles' heel of liver transplantation. The most common complications are leaks and bile duct strictures. Strictures can arise at the level of the anastomosis (anastomotic strictures; AS) or at other locations in the biliary tree (non-anastomotic strictures; NAS). Endoscopic treatment via endoscopic retrograde cholangiopancreatography (ERCP) is considered to be the preferred therapy for these complications. This review will focus on the diagnostic modalities, new insights in etiology of biliary complications and outcomes after different endoscopic therapies, in both deceased donor transplantation and living-donor liver transplantations. Advances in recent therapies, such as the use of self-expendable metal stents (SEMS) and endoscopic therapy for patients with a bilio-digestive anastomosis will be discussed.
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Nordenström J, Holmdahl G, Brandström P, Sixt R, Stokland E, Sillén U, Sjöström S. The Swedish infant high-grade reflux trial: Study presentation and vesicoureteral reflux outcome. J Pediatr Urol 2017; 13:130-138. [PMID: 27889221 DOI: 10.1016/j.jpurol.2016.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION High-grade vesicoureteral reflux (VUR) in infants is associated with congenital renal abnormalities, recurrent UTI, and bladder dysfunction. Endoscopic treatment (ET) is a well-established method in children with low to moderate reflux grades, but there is a lack of randomised controlled trials regarding the use of ET versus continuous antibiotic prophylaxis in infants with high-grade VUR. OBJECTIVE This study aimed to determine whether high-grade VUR in infants can be treated with endoscopic injection and whether ET is superior to antibiotic prophylaxis in the treatment of VUR. MATERIALS AND METHODS This prospective, randomised, controlled, multicentre, 1-year follow-up trial comprised 77 infants (55 boys, 22 girls) <8 months of age with VUR grade 4-5 (n = 30/n = 47). Of the infants, 52 (68%) had bilateral VUR. Thirty-nine were randomised to antibiotic prophylaxis and 38 to ET (with prophylaxis until resolution). Voiding cystourethrogram, ultrasound, renal scintigraphy, and free voiding observation were performed at study entry and after 1 year to evaluate VUR grade, and renal and bladder function. RESULTS VUR grade ≤2 was seen in 22 (59%) infants in the endoscopy group and eight (21%) in the prophylaxis group at follow-up (p = 0.0014). The success rate in the endoscopy group was 100% in unilateral grade 4, falling to 31% in bilateral grade 5 (p = 0.0094). Correspondingly, the results in the prophylaxis group were 40% in grade 4 down to 0% in bilateral grade 5 (p = 0.037) (Table). Logistic regression analyses identified ET, VUR grade 4, unilaterality, and low residual urine at baseline as positive predictors of VUR down-grading to ≤2 (area under ROC curve 0.88). In four patients with reflux resolution after one injection, dilating reflux recurred at the 1-year follow-up. One patient had a UTI possibly related to ET. In our material four patients required re-implantation, of whom one was obstructive after injection. DISCUSSION The opportunity to offer even small infants with high-grade VUR an alternative, minimally invasive treatment option is a great advance in paediatric urology. In this high-risk group, bilateral VUR grade 5 stands out with its poor bladder function and low chance of resolution. The recurrence rate of dilating VUR after successful ET is consistent with previous studies. The limitations are the relatively small number of patients and the short follow-up. CONCLUSION High-grade VUR in infants can be treated with injection therapy and the resolution rate is higher than that of prophylaxis treatment. The complication rate is low and VUR grade 4, unilaterality, and low residual urine are favourable for the resolution and down-grading of VUR.
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Affiliation(s)
- Josefin Nordenström
- Department of Paediatric Surgery, Paediatric Uronephrologic Centre, Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Gundela Holmdahl
- Department of Paediatric Surgery, Paediatric Uronephrologic Centre, Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Per Brandström
- Department of Paediatrics, Paediatric Uronephrologic Centre, Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Rune Sixt
- Department of Paediatric Clinical Physiology, Paediatric Uronephrologic Centre, Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Eira Stokland
- Department of Paediatric Radiology at the Paediatric Uronephrologic Centre, Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ulla Sillén
- Department of Paediatric Surgery, Paediatric Uronephrologic Centre, Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Sofia Sjöström
- Department of Paediatric Surgery, Paediatric Uronephrologic Centre, Queen Silvia Children's Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Cherrington AD, Rajagopalan H, Maggs D, Devière J. Hydrothermal Duodenal Mucosal Resurfacing: Role in the Treatment of Metabolic Disease. Gastrointest Endosc Clin N Am 2017; 27:299-311. [PMID: 28292408 DOI: 10.1016/j.giec.2016.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The duodenum has become recognized as a metabolic signaling center that is involved in regulating insulin action and, therefore, insulin resistance states such as type 2 diabetes. Bariatric surgery and other manipulations of the upper intestine, in particular the duodenum, have shown that limiting nutrient exposure or contact in this key region exerts powerful metabolic effects. Early human clinical trial data suggest that endoscopic hydrothermal duodenal mucosal resurfacing is well tolerated in human subjects and has an acceptable safety profile. This article describes the rationale for this endoscopic approach and its early human use, including safety, tolerability, and early efficacy.
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Affiliation(s)
- Alan D Cherrington
- Molecular Physiology & Biophysics, Vanderbilt University School of Medicine, 704A/710 Robinson Research Building, 2200 Pierce Avenue, Nashville, TN 37232-0615, USA.
| | | | - David Maggs
- Fractyl Laboratories, Inc, 17 Hartwell Avenue, Lexington, MA 02421, USA
| | - Jacques Devière
- Medical-Surgical Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, Brussels 1070, Belgium
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Souto-Rodríguez R, Alvarez-Sánchez MV. Endoluminal solutions to bariatric surgery complications: A review with a focus on technical aspects and results. World J Gastrointest Endosc 2017; 9:105-126. [PMID: 28360973 PMCID: PMC5355758 DOI: 10.4253/wjge.v9.i3.105] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/12/2016] [Accepted: 12/14/2016] [Indexed: 02/06/2023] Open
Abstract
Obesity is a growing problem in developed countries, and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients. Despite the advances in surgical techniques, some patients still develop acute and late postoperative complications, and an endoscopic evaluation is often required for diagnosis. Moreover, the high morbidity related to surgical reintervention, the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery, and, in many cases, a suitable first-line treatment of bariatric surgery complications. There is now evidence in the literature supporting endoscopic management for some of these complications, such as gastrointestinal bleeding, stomal and marginal ulcers, stomal stenosis, leaks and fistulas or pancreatobiliary disorders. However, endoscopic treatment in this setting is not standardized, and there is no consensus on its optimal timing. In this article, we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment. Based on a thorough review of the literature, we evaluated the performance and safety of different endoscopic options for every type of complication, highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.
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143
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Plat VD, Bootsma BT, van der Wielen N, Straatman J, Schoonmade LJ, van der Peet DL, Daams F. The role of tissue adhesives in esophageal surgery, a systematic review of literature. Int J Surg 2017; 40:163-168. [PMID: 28285057 DOI: 10.1016/j.ijsu.2017.02.093] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/25/2017] [Accepted: 02/27/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anastomotic leakage following esophageal surgery is a major contributor to mortality. According to the national database leakage occurs in 20% of esophagectomies carried out in the Netherlands. Therefore anastomotic leakage has been the topic of many studies. However, studies discussing application of tissue adhesives for either prevention or management of anastomotic leakage are limited. This article systematically reviewed all available literature on the potential use of tissue adhesives in esophageal surgery. METHODS Medline, Embase and Cochrane were searched to identify studies that used tissue adhesives as anastomotic sealants to prevent esophageal anastomotic leakage or used tissue adhesives to treat esophageal anastomotic leakage. Two authors independently selected nineteen out of 3107 articles. RESULTS Eight articles, of which five were experimental and three clinical, discussed prevention of anastomotic leakage. Eleven articles, of which one was experimental and ten clinical, discussed treatment of anastomotic leakage. Most articles reported positive results, however overall quality was low due to a high degree of bias and lack of homogeneity. CONCLUSION This study shows mainly positive results for the use of tissue adhesives for the esophageal anastomosis both in prevention of leakage as treating anastomotic leakage. However, the quality of current literature is poor.
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Affiliation(s)
- Victor Dirk Plat
- Department of Gastrointestinal Surgery, VU University Medical Center Amsterdam, The Netherlands.
| | - Boukje Titia Bootsma
- Department of Gastrointestinal Surgery, VU University Medical Center Amsterdam, The Netherlands
| | - Nicole van der Wielen
- Department of Gastrointestinal Surgery, VU University Medical Center Amsterdam, The Netherlands
| | - Jennifer Straatman
- Department of Gastrointestinal Surgery, VU University Medical Center Amsterdam, The Netherlands
| | | | | | - Freek Daams
- Department of Gastrointestinal Surgery, VU University Medical Center Amsterdam, The Netherlands
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Fujishiro M, Yoshida S, Matsuda R, Narita A, Yamashita H, Seto Y. Updated evidence on endoscopic resection of early gastric cancer from Japan. Gastric Cancer 2017; 20:39-44. [PMID: 27704225 DOI: 10.1007/s10120-016-0647-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/23/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic resection for early gastric cancer (EGC) plays a central role in the treatment of EGC in Japan. However, there is still room for improvement, and it is necessary to summarize the recently obtained knowledge from Japan for further improvement. METHODS We conducted a PubMed search to select relevant articles in the 5 years until September 18, 2016, using the keywords "gastric cancer" and "endoscopic treatment," "endoscopic submucosal dissection," "endoscopic mucosal resection," or "polypectomy" and filtering article types as "clinical study" or "clinical trial." RESULTS Among the 329 articles selected automatically from the keywords "polypectomy" (1 article), "endoscopic mucosal resection" (29 articles), "endoscopic submucosal dissection" (77 articles), and "endoscopic treatment" (222 articles) in combination with "gastric cancer," 32 relevant articles from Japanese investigators were chosen. Seven articles were categorized into "equipment," 4 into "preparation and sedation," 17 into "complications and their prevention," and 4 into "therapeutic outcomes." Among them, CO2 insufflation, propofol sedation, and how to prevent post-endoscopic submucosal dissection (ESD) ulcer bleeding and achieve post-ESD ulcer healing were intensively investigated. Long-term outcomes of endoscopic mucosal resection and ESD were also reported as favorable outcomes. CONCLUSIONS Endoscopic resection for EGC is still developing toward an ideal form, pursuing a more reliable, safer, and faster minimally invasive treatment.
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Affiliation(s)
- Mitsuhiro Fujishiro
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Shuntaro Yoshida
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Rie Matsuda
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akiko Narita
- Department of Endoscopy and Endoscopic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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145
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Wei Y, Gong JF, Zhu WM. Endoscopic closure instead of surgery to close an ileal pouch fistula with the over-the-scope clip system. World J Gastrointest Endosc 2017; 9:95-98. [PMID: 28250903 PMCID: PMC5311479 DOI: 10.4253/wjge.v9.i2.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/05/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023] Open
Abstract
An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and has a high risk compared to endoscopic treatment. The over-the-scope clip (OTSC) system was initially developed for hemostasis and leakage closure in the gastrointestinal tract during flexible endoscopy. There have been many successes in using this approach to apply perforations to the upper gastrointestinal tract. However, this approach has not been used for ileal pouch fistulas until currently. In this report, we describe one patient who suffered a leak from the tip of the “J” pouch and was successfully treated with endoscopic closure via the OTSC system. A 26-year-old male patient had an intestinal fistula at the tip of the “J” pouch after an ileal pouch anal anastomosis procedure. He received endoscopic treatment via OTSC under intravenous anesthesia, and the leak was closed successfully. Endoscopic closure of a pouch fistula could be a simpler alternative to surgery and could help avoid surgery-related complications.
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146
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Isayama H, Nakai Y, Hamada T, Matsubara S, Kogure H, Koike K. Understanding the Mechanical forces of Self-Expandable Metal Stents in the Biliary Ducts. Curr Gastroenterol Rep 2016; 18:64. [PMID: 27778304 DOI: 10.1007/s11894-016-0538-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Self-expandable metallic stent (SEMS) was an effective biliary endoprosthesis. Mechanical properties of SEMS, radial and axial force (RF, AF), may play important roles in the bile duct after placement. RF was well known dilation force and influenced on the occurrence of migration. AF, newly proposed by this author, was defined as the recovery force when the SEMS vended. AF was related with the cause of bile duct kinking, pancreatitis, and cholecystitis due to the compression of the bile duct, orifice of the cystic duct, and pancreatic orifice. Ideal SEMS may show high RF and low AF.
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147
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Siow SL, Mahendran HA, Seo CJ. Complication and remission rates after endoscopic argon plasma coagulation in the treatment of haemorrhagic radiation proctitis. Int J Colorectal Dis 2017; 32:131-134. [PMID: 27527929 DOI: 10.1007/s00384-016-2635-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE The management of haemorrhagic radiation proctitis is challenging because of the necessity for repeated intervention. The efficacy of argon plasma coagulation has been described before but the optimum treatment strategy remains debatable. This is a review of our experience over a decade treating patients with haemorrhagic radiation proctitis and their follow-up. METHODS This is a retrospective review of consecutive patients who underwent argon plasma coagulation for haemorrhagic radiation proctitis between January 2003 and December 2013. The patients were followed up using a prospectively maintained database. RESULTS Ninety-one patients were included with a mean follow-up of 13.1 months. Majoity (n = 85, 93.4 %) of the patients were female. Mean age at the time of treatment was 58.2 (range 23-87) years old. Majority of the patients (n = 73, 80.2 %) received radiotherapy for gynaecological malignancies followed by colorectal (n = 13, 14.3 %) and urological (n = 5, 5.5 %) malignancies. Mean interval between radiation and proctitis was 13.8 (range 3-40) months. Seventy-nine percent of patients were successfully treated after 1-2 sessions. Seventeen (18.7 %) patients experienced self-limiting early complications, and three (3.3 %) had late complications of rectal stenosis which was managed conservatively. Severity of bleeding during the initial presentation is an independent factor that predicts the number of sessions required for successful haemostasis (p = 0.002). CONCLUSIONS Argon plasma coagulation is a reasonable treatment option in patients with haemorrhagic radiation proctitis with good safety profile. Our study suggests that the number of APC sessions required to arrest bleeding correlates with the severity of bleeding on initial presentation.
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Affiliation(s)
- S L Siow
- Department of Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia. .,Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Kuching, Sarawak, Malaysia.
| | - H A Mahendran
- Department of Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - C J Seo
- Department of Surgery, Sarawak General Hospital, Kuching, Sarawak, Malaysia
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Grassia R, Capone P, Iiritano E, Vjero K, Cereatti F, Martinotti M, Rozzi G, Buffoli F. Non-variceal upper gastrointestinal bleeding: Rescue treatment with a modified cyanoacrylate. World J Gastroenterol 2016; 22:10609-10616. [PMID: 28082813 PMCID: PMC5192272 DOI: 10.3748/wjg.v22.i48.10609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/13/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the safety and efficacy of a modified cyanoacrylate [N-butyl-2-cyanoacrylate associated with methacryloxysulfolane (NBCA + MS)] to treat non-variceal upper gastrointestinal bleeding (NV-UGIB).
METHODS In our retrospective study we took into account 579 out of 1177 patients receiving endoscopic treatment for NV-UGIB admitted to our institution from 2008 to 2015; the remaining 598 patients were treated with other treatments. Initial hemostasis was not achieved in 45 of 579 patients; early rebleeding occurred in 12 of 579 patients. Thirty-three patients were treated with modified cyanoacrylate: 27 patients had duodenal, gastric or anastomotic ulcers, 3 had post-mucosectomy bleeding, 2 had Dieulafoy’s lesions, and 1 had duodenal diverticular bleeding.
RESULTS Of the 45 patients treated endoscopically without initial hemostasis or with early rebleeding, 33 (76.7%) were treated with modified cyanoacrylate glue, 16 (37.2%) underwent surgery, and 3 (7.0%) were treated with selective transarterial embolization. The mean age of patients treated with NBCA + MS (23 males and 10 females) was 74.5 years. Modified cyanoacrylate was used in 24 patients during the first endoscopy and in 9 patients experiencing rebleeding. Overall, hemostasis was achieved in 26 of 33 patients (78.8%): 19 out of 24 (79.2%) during the first endoscopy and in 7 out of 9 (77.8%) among early rebleeders. Two patients (22.2%) not responding to cyanoacrylate treatment were treated with surgery or transarterial embolization. One patient had early rebleeding after treatment with cyanoacrylate. No late rebleeding during the follow-up or complications related to the glue injection were recorded.
CONCLUSION Modified cyanoacrylate solved definitively NV-UGIB after failure of conventional treatment. Some reported life-threatening adverse events with other formulations, advise to use it as last option.
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149
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Lim SH, Levenick JM, Mathew A, Moyer MT, Dye CE, McGarrity TJ. Endoscopic Management of Large (≥2 cm) Non-pedunculated Colorectal Polyps: Impact of Polyp Morphology on Outcomes. Dig Dis Sci 2016; 61:3572-3583. [PMID: 27696095 DOI: 10.1007/s10620-016-4314-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Referrals for endoscopic management of large non-pedunculated (NP) colorectal polyps have increased as new techniques have emerged. The outcomes for referred large NP polyps based on the polyp morphology were investigated METHODS: A retrospective review of patients referred for large (≥20 mm) NP polyp management from January 2010 through June 2014 was completed. Polyp morphology was classified as either a NP polyp with depression (M1) or NP polyp with no depression (M0). Differences in treatment, histology, adverse events, outcomes at follow-up including residual disease, and need for surgical treatment were determined by morphology for all NP polyps ≥20 mm in size. RESULTS One-hundred and sixty-nine M1 and 136 M0 polyps ≥20 mm were removed endoscopically during the review period. Mean size was 31.9 ± 11.0 mm in M1, and 26.8 ± 9.5 mm in M0 group (p < 0.0001). En bloc resection was possible in 18.3 % of M1 and 30.9 % of M0 lesions (p = 0.011) with endoscopic submucosal dissection used in 13 and 2.2 % of polyps, respectively (p < 0.0001). Residual polyp was found in 26.5 % (27/102) of M1 and 13.6 % (12/88) of M0 patients at surveillance colonoscopy (p = 0.029). On multivariate analysis, piecemeal resection and M1 morphology showed significant association with residual polyp (OR 4.23, 95 % CI 1.23-14.59, p = 0.022, and OR 2.15, 95 % CI 1.004-4.62, p = 0.049, respectively). CONCLUSION Effective endoscopic management of large NP colorectal polyps, especially polyps without depression (M0), can be accomplished in the great majority of patients. Polyp morphology, particularly the presence or absence of depression, is a useful tool which influenced treatment, histology, and outcomes.
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Affiliation(s)
- Seon Hee Lim
- Division of Gastroenterology, Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, 138-984, Korea
| | - John M Levenick
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Abraham Mathew
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Matthew T Moyer
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Charles E Dye
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
| | - Thomas J McGarrity
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, HU33, 500 University Drive, Hershey, PA, 17033-0850, USA
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Yap TL, Chen Y, Nah SA, Ong CC, Jacobsen A, Low Y. STING versus HIT technique of endoscopic treatment for vesicoureteral reflux: A systematic review and meta-analysis. J Pediatr Surg 2016; 51:2015-20. [PMID: 27773360 DOI: 10.1016/j.jpedsurg.2016.09.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022]
Abstract
AIM Our study aimed to compare the efficacy of two endoscopic techniques used for the correction of vesicoureteral reflux (VUR): subureteral transurethral injection (STING) and hydrodistension implantation technique (HIT). METHODS A systematic review was conducted using MEDLINE, Google scholar, and Cochrane databases from 1984 to 2015. Meta-analysis of the selected studies was performed to compare the extent of reflux resolution following both techniques. RESULTS Six observational studies met the inclusion criteria for content. These comprised 632 ureters treated by STING and 895 ureters treated by HIT procedure. All included studies utilized dextranomer/hyaluronic acid (Deflux) as the bulking agent. The overall resolution of VUR was significantly higher in HIT (82.5%) compared to STING (71.4%) [pooled odds ratio (OR)=0.54; 95% confidence interval (CI) 0.42-0.69; P<0.0001; I2=8%]. A subgroup analysis showed that HIT had better outcomes than STING for both lower grade (I-III) [OR=0.43; 95% CI 0.23-0.82; P=0.01; I2=0%] and high-grade VUR (IV-V) [OR=0.43; 95% CI 0.20-0.91; P=0.03; I2=0%]. However, there was no statistical difference in the requirement of additional injections between STING and HIT groups. CONCLUSION HIT is superior to STING technique for resolution of VUR after Deflux injection. However, more randomized trials with longer follow-up are necessary to demonstrate the benefit of HIT compared to STING procedure. LEVEL OF EVIDENCE Retrospective comparative studies - level III.
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