7651
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Yeh HY, Chao HC, Chen SY, Chen CC, Lai MW. Analysis of Radiopaque Gastrointestinal Foreign Bodies Expelled by Spontaneous Passage in Children: A 15-Year Single-Center Study. Front Pediatr 2018; 6:172. [PMID: 29946536 PMCID: PMC6006757 DOI: 10.3389/fped.2018.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 03/01/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Most ingested foreign bodies (FBs) pass spontaneously through the gastrointestinal (GI) tract, but only limited data on transit time are available. We evaluated the relationship of FB size and shape with transit time. Methods: We retrospectively reviewed medical records collected over 15 years (January 2001 to December 2015) on pediatric patients with radiopaque FBs in the GI tract. We categorized the FBs as regularly (round or spherical) or irregularly shaped (ovoid, long, flake-like, or projecting) and measured their sizes radiographically. The diameter of regularly shaped FBs and the length of irregularly shaped FBs were correlated with transit time. Results: In total, 484 patients with GI FBs were surveyed, and 267 (55.1%) FBs were radiopaque. Among the 267 radiopaque FBs, 88 (33.1%) required endoscopic removal and 7 (2.6%) underwent surgical intervention. Eighty-seven patients with single FBs in the GI tract for whom precise details of transit time were enrolled into the analysis of transit time; their mean age was 3.48 ± 2.21 years. Of the 87 FBs, 61 (70.1%) were regularly shaped, and 26 (29.9%) were irregularly shaped. The diameter of regularly shaped FBs was positively associated with transit time, as revealed by Mann-Whitney U test; diameters >1.5 and >2 cm were significantly correlated with longer transit times (both p = 0.003). A trend toward an increased transit time for long irregularly shaped FBs was also apparent; the p-values for lengths of 1.5, 2, and 2.5 cm were 0.824, 0.153, and 0.055, respectively. Under receiver operating characteristic (ROC) curve analysis, the optimal cutoff diameter for regularly shaped FBs, and length for irregularly shaped FBs, to predict a transit time of longer than 72 h were 1.95 and 2.25 cm, respectively. Conclusions: The passage rate of ingested radiopaque FBs is 64.4%. Small FBs that have passed the duodenal curve should be managed conservatively via clinical observation and radiographic surveillance. Our results indicate that the larger an FB is, the longer the transit time will be.
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Affiliation(s)
- Hung-Yu Yeh
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsun-Chin Chao
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Yen Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Chang Chen
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Gastroenterology, Department of Pediatrics, Chang Gung Children's Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Canena J. Once upon a Time a Guideline Was Used for the Evaluation of Suspected Choledocholithiasis: A Fairy Tale or a Nightmare? GE Port J Gastroenterol 2018; 25:6-9. [PMID: 29457044 PMCID: PMC5806156 DOI: 10.1159/000481688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 09/20/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Jorge Canena
- Centro de Gastrenterologia do Hospital Cuf Infante Santo, Nova Medical School - Faculdade de Ciências Médicas da UNL, Lisbon, Serviço de Gastrenterologia do Hospital Amadora-Sintra, Amadora, Serviço de Gastrenterologia do Hospital de Santo António dos Capuchos, CHLC, Lisbon, and CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
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7653
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Berg D, Chakinala RC, Veillette G, Schorr-lesnick B. Endoscopic versus Surgical Intervention for Jejunal Bezoar Formation. ACG Case Rep J 2018; 5:e871-3. [DOI: 10.14309/02075970-201805120-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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7654
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Vegiraju VK, Shetty S, Leelakrishnan V, Janarthanan K, Mohandas N, Balakshmoji D. Role of noninvasive markers to predict the presence of esophageal varices in cirrhosis: Pilot study. Indian J Gastroenterol 2018; 37:74-5. [PMID: 29455439 DOI: 10.1007/s12664-018-0834-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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7655
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Hinkelbein J, Lamperti M, Akeson J, Santos J, Costa J, De Robertis E, Longrois D, Novak-jankovic V, Petrini F, Struys MM, Veyckemans F, Fuchs-buder T, Fitzgerald R. European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults. Eur J Anaesthesiol 2018; 35:6-24. [DOI: 10.1097/eja.0000000000000683] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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7656
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Hollins SL, Brock L, Barreto R, Harms L, Dunn A, Garcia-Sobrinho P, Bruce J, Dickson PW, Walker MM, Keely S, Hodgson DM. A Rodent Model of Anxiety: The Effect of Perinatal Immune Challenges on Gastrointestinal Inflammation and Integrity. Neuroimmunomodulation 2018; 25:163-175. [PMID: 30415249 DOI: 10.1159/000493320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 05/31/2018] [Accepted: 08/23/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Gastrointestinal (GI) inflammation and GI integrity deficits are common comorbidities of neuropsychiatric disorders. Ongoing research suggests that these aberrations may be contributing to heightened immune signals that have the potential to disrupt neuronal homeostasis and exacerbate behavioural deficits. The current study aimed to determine whether the well-characterized animal model of neuropsychopathology, the maternal immune activation (MIA) model, produced GI inflammation and integrity disruptions in association with anxiety-like behaviour. METHODS Pregnant Wistar rats were exposed to the viral mimetic polyriboinosinic:polyribocytidilic acid (polyI:C) on gestational days (GD) 10 and 19. Evidence of ANS activation, GI inflammation, and GI barrier integrity was assessed in both neonatal (postnatal day, P7) and adult (P84) offspring. Anxiety-like behaviour was assessed at P100. RESULTS Neonatal MIA offspring exhibited an altered intestinal inflammatory profile and evidence of an increase in lymphoid aggregates. MIA neonates also displayed disruptions to GI barrier tight junction protein mRNA. In addition, adult MIA offspring exhibited an increase in anxiety-like behaviours. CONCLUSION These results indicate that the MIA rat model, which is well documented to produce behavioural, neurochemical, and neuroanatomical abnormalities, also produces GI inflammation and integrity disruptions. We suggest that this model may be a useful tool to elucidate biological pathways associated with neuropsychiatric disorders.
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Affiliation(s)
- Sharon L Hollins
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia,
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia,
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia,
| | - Luke Brock
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rafael Barreto
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Lauren Harms
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Ariel Dunn
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
| | - Pedro Garcia-Sobrinho
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jessica Bruce
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Phillip W Dickson
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Marjorie M Walker
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Simon Keely
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia
| | - Deborah M Hodgson
- Laboratory of Neuroimmunology, School of Psychology, University of Newcastle, Callaghan, New South Wales, Australia
- Priority Research Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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7657
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Sedhom D, Herrmann A, Dʼsouza M, Fyfe B, Zaldana F, Schlesinger N, Rustgi V. Vanishing Bile Duct Syndrome in a Patient with Uterine Cancer and Paraneoplastic Systemic Sclerosis: . ACG Case Rep J 2018; 5:e951-5. [DOI: 10.14309/02075970-201805120-00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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7658
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Xu W, He L, Xia Q, Jia C, Geng L, Yang M, Xu Z, Chen P, Cheng Y, Zhao J, Wang H, Chen H, Zhang Y, Gong S, Liu R. A far-red-emissive AIE active fluorescent probe with large stokes shift for detection of inflammatory bowel disease in vivo. J Mater Chem B 2018; 6:809-815. [DOI: 10.1039/c7tb03168h] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Inflammatory bowel disease (IBD) is a group of chronic remittent or progressive inflammatory gastrointestinal tract diseases, accompanying impaired barrier function.
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7659
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Jung Y, Lee J, Cho JY, Kim YD, Park CG, Kim MW, Kim KJ, Kim SW. Comparison of efficacy and safety between endoscopic submucosal dissection and transanal endoscopic microsurgery for the treatment of rectal tumor. Saudi J Gastroenterol 2018; 24:115-121. [PMID: 29637919 PMCID: PMC5900471 DOI: 10.4103/sjg.sjg_440_17] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIM To compare the treatment efficacy and safety between endoscopic submucosal dissection (ESD) and transanal endoscopic microsurgery (TEM) for the treatment of rectal epithelial tumors, including large adenoma, cancer, and subepithelial tumors (SET). PATIENTS AND METHODS We conducted a retrospective analysis of the medical records of 71 patients with rectal tumors who were treated with ESD (48 patients) or TEM (23 patients) from January 2013 to December 2015. The patient group comprised 56 patients with epithelial tumors and 15 patients with SET. Treatment efficacy such as en bloc resection, procedure time, local recurrence, hospital stay, additional procedure rate, and safety between the treatment groups were evaluated and analyzed. RESULTS There were no significant differences in tumor size, location, macroscopic appearance, and histological depth between ESD and TEM groups. For ESD compared to TEM in rectal epithelial tumors, en bloc resection rates were 95% vs. 93.7% and R0 resection rates were 92.5% vs. 87.5% (P = 0.617); in rectal SET, en bloc resection rates were 100% vs. 100% and R0 resection rates were 87% vs. 85% (P = 0.91). The procedure time was 71.5 ± 51.3 min vs. 105.6 ± 28.2 min (P = 0.016) for epithelial tumors and 32.13 ± 13.4 min vs. 80.71 ± 18.35 min (P = 0.00) for SET, respectively. Hospital stay was 4.3 ± 1.2 days vs. 5.8 ± 1.8 days (P = 0.001) for epithelial tumors and 4.1 ± 4.1 days vs. 5.5 ± 2 days (P = 0.42) for rectal SET, respectively. There were no significant differences between recurrence rates, additional procedure rates, and complications in the two groups. CONCLUSIONS ESD and TEM are both effective and safe for the treatment of rectal epithelial tumors and SET because of favorable R0 resection rates and recurrence rates. However, the ESD group showed shorter procedure times and hospital stays than the TEM group. Therefore, ESD should be considered more preferentially than TEM in the treatment of large rectal epithelial tumors and SET.
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Affiliation(s)
- Yun Jung
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Jun Lee
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea,Address for correspondence: Dr. Jun Lee, Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea. E-mail:
| | - Ju Yeon Cho
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Young Dae Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Chan Guk Park
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Man Woo Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Kyung Jong Kim
- Department of Surgery, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Se Won Kim
- Department of Surgery, College of Medicine, Chosun University, Gwangju, Republic of Korea
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7660
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Neuschmelting V, Kim K, Malekzadeh-Najafabadi J, Jebiwott S, Prakash J, Scherz A, Coleman JA, Kircher MF, Ntziachristos V. WST11 Vascular Targeted Photodynamic Therapy Effect Monitoring by Multispectral Optoacoustic Tomography (MSOT) in Mice. Am J Cancer Res 2018; 8:723-734. [PMID: 29344301 PMCID: PMC5771088 DOI: 10.7150/thno.20386] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 08/11/2017] [Indexed: 11/05/2022] Open
Abstract
Objective: Monitoring emerging vascular-targeted photodynamic therapy (VTP) and understanding the time-dynamics of treatment effects remains challenging. We interrogated whether handheld multispectral optoacoustic tomography (MSOT) could noninvasively monitor the effect of VTP using WST11, a vascular-acting photosensitizer, on tumor tissues over time using a renal cell cancer mouse model. We also investigated whether MSOT illumination can induce VTP, to implement a single-modality theranostic approach. Materials and Methods: Eight BalB/c mice were subcutaneously implanted with murine renal adenocarcinoma cells (RENCA) on the flank. Three weeks later VTP was performed (10 min continuous illumination at 753 nm following intravenous infusion using WST11 or saline as control. Handheld MSOT images were collected prior to VTP administration and subsequently thereafter over the course of the first hour, at 24 and 48 h. Data collected were unmixed for blood oxygen saturation in tissue (SO2) based on the spectral signatures of deoxy- and oxygenated hemoglobin. Changes in oxygen saturation over time, relative to baseline, were examined by paired t-test for statistical significance (p < 0.05). In-vivo findings were corroborated by histological analyses of the tumor tissue. Results: MSOT is shown to prominently resolve changes in oxygen saturation in tumors within the first 20 min post WST11-VTP treatment. Within the first hour post-treatment, SO2 decreased by more than 60% over baseline (p < 0.05), whereas it remained unchanged (p > 0.1) in the sham-treated group. Moreover, unlike in the control group, SO2 in treated tumors further decreased over the course of 24 to 48 h post-treatment, concomitant with the propagation of profound central tumor necrosis present in histological analysis. We further show that pulsed MSOT illumination can activate WST11 as efficiently as the continuous wave irradiation employed for treatment. Conclusion: Handheld MSOT non-invasively monitored WST11-VTP effects based on the SO2 signal and detected blood saturation changes within the first 20 min post-treatment. MSOT may potentially serve as a means for both VTP induction and real-time VTP monitoring in a theranostic approach.
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7661
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Affiliation(s)
- Judith E Baars
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Fei Chen
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Charbel Sandroussi
- Department of Hepatobiliary and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Arthur J Kaffes
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Payal Saxena
- Department of Gastroenterology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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7662
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Abstract
The value of laryngotracheobronchoscopy (LTB) immediately prior to repair of esophageal atresia with or without tracheo-esophageal fistula is contentious. Currently, there is a wide range of opinion on the utility of this investigation which is reflected by huge variation in clinical practice. This review is a critical analysis of the arguments for and against performing routine LTB prior to esophageal atresia repair. Reserving LTB for selected cases only is potentially disadvantageous since it limits the surgeon's and anesthetist's familiarity with the procedure, equipment, and range of potential findings. There is sufficient evidence to suggest that routine preoperative LTB becomes the standard of care.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Mark D Stringer
- Department of Paediatric Surgery, Wellington Children's Hospital, Riddiford Street, Newtown, Wellington, 6021, New Zealand. .,Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand.
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7663
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Zhang LY, Li WY, Ji M, Liu FK, Chen GY, Wu SS, Hao Q, Zhai HH, Zhang ST. Efficacy and safety of using premedication with simethicone/Pronase during upper gastrointestinal endoscopy examination with sedation: A single center, prospective, single blinded, randomized controlled trial. Dig Endosc 2018; 30:57-64. [PMID: 28816373 DOI: 10.1111/den.12952] [Citation(s) in RCA: 12] [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: 05/11/2017] [Accepted: 08/14/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM To investigate the efficacy and safety of premedication with simethicone/Pronase during esophagogastroduodenoscopy (EGD) with sedation. METHODS Six hundred and ten patients were randomly allocated to two groups based on type of premedication given. Premedication used in the control group was 10 mL lidocaine hydrochloride mucilage (LHM, N = 314) and premedication used in the intervention group was 80 mL simethicone/Pronase solution plus 10 mL lidocaine hydrochloride mucilage (SP/LHM, N = 296). EGD was done under sedation. Visibility scores, number of mucosal areas that needed cleansing, water consumption for cleansing, time taken for examination, diminutive lesions, pathological diagnosis, patients' gag reflex and oxygenation (pulse oximetry) were recorded. RESULTS SP/LHM has significantly lower total visibility score than LHM (7.978 ± 1.526 vs 6.348 ± 1.097, P < 0.01). During the procedure, number of intragastric areas that needed cleansing and amount of water consumed were significantly less in the SP/LHM than in the LHM group (P < 0.01). In SP/LHM (P = 0.01), endoscopy procedure duration was significantly longer. Although there was no significant difference in rate of detection of diminutive lesions between LHM and SP/LHM, the endoscopist carried out more biopsies in SP/LHM. This led to a higher rate of diagnosis of atrophic gastritis (P = 0.014) and intestinal metaplasia (P = 0.024). There was no significant difference in gag reflex (P = 0.604) and oxygenation during the endoscopy procedure for either group of patients. CONCLUSION Routine use of premedication with simethicone/Pronase should be recommended during EGD with sedation.
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Affiliation(s)
- Ling-Ye Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Wen-Yan Li
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Ming Ji
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Fu-Kun Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Guang-Yong Chen
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shan-Shan Wu
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Qian Hao
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Hui-Hong Zhai
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Shu-Tian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
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7664
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Krajicek E, Sherman S, Lacerda M, Johnson MS, Vuppalanchi R. Ischemic Cholangiopathy 11 Years after Liver Transplantation from Asymptomatic Chronic Hepatic Artery Thrombosis. ACG Case Rep J 2018; 5:e751-3. [DOI: 10.14309/02075970-201805100-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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7665
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Kobayashi Y, Komazawa Y, Yuki M, Ishitobi H, Nagaoka M, Takahashi Y, Nakashima S, Shizuku T, Kinoshita Y. Use of anticoagulant or antiplatelet agents is not related to epistaxis in patients undergoing transnasal endoscopy. Endosc Int Open 2018; 6:E104-E110. [PMID: 29344570 PMCID: PMC5770266 DOI: 10.1055/s-0043-124366] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Unsedated transnasal endoscopy (uTNE) has become accepted as a safe and tolerable method for upper gastrointestinal tact examinations. Epistaxis is 1 of the major complications of TNE, though its risk factors have not been elucidated. Generally, patients administered an anticoagulant or antiplatelet drug are considered to have an increased risk of epistaxis during TNE. Here, we investigated risk factors of epistaxis in patients undergoing uTNE, with focus on those who received antithrombotic agents. PATIENTS AND METHODS We enrolled 6860 patients (average age 55.6 ± 12.97 years; 3405 males, 3455 females) who underwent uTNE and received the same preparations for the procedure. Epistaxis was evaluated using endoscopic images obtained while withdrawing the scope through the nostril. We also noted current use of medications including anticoagulant or antiplatelet agents prior to the endoscopic examination. RESULTS Epistaxis occurred in 3.6 % of the enrolled patients (245/6860), and that rate was significantly higher in younger patients (average age 49.31 ± 11.8 years for epistaxis group vs. 55.83 ± 13.0 years for no epistaxis group, P < 0.01) as well as females (4.78 % vs. 2.35 %, P < 0.01). The odds ratio for occurrence of epistaxis was 2.31 (95 %CI: 1.746 - 3.167) in the younger patients and 2.02 (95 % CI: 1.542 - 2.659) in females. In contrast, there was no significant difference for rate of epistaxis between patients with and without treatment with an antithrombotic agent (3.0 % vs. 3.6 %). CONCLUSIONS The rate of epistaxis was higher in younger and female patients. Importantly, that rate was not significantly increased in patients who were administered an antithrombotic agent.
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Affiliation(s)
- Yoshiya Kobayashi
- Department of Internal Medicine, Izumo City General Medical Center, Shimane, Japan,Corresponding author Yoshiya Kobayashi Division of Internal MedicineIzumo City General Medical Center613, Nadabun, IzumoShimane, 691-0003Japan+81-853-63-4228
| | - Yoshinori Komazawa
- Department of Internal Medicine, Izumo City General Medical Center, Shimane, Japan
| | - Mika Yuki
- Department of Internal Medicine, Izumo City General Medical Center, Shimane, Japan
| | - Hitomi Ishitobi
- Department of Internal Medicine, Izumo City General Medical Center, Shimane, Japan
| | - Makoto Nagaoka
- Department of Internal Medicine, Izumo City General Medical Center, Shimane, Japan
| | - Yoshiko Takahashi
- Department of Internal Medicine, Izumo City General Medical Center, Shimane, Japan
| | - Sayaka Nakashima
- Department of Internal Medicine, Izumo City General Medical Center, Shimane, Japan
| | - Toshihiro Shizuku
- Department of Internal Medicine, Izumo City General Medical Center, Shimane, Japan
| | - Yoshikazu Kinoshita
- Department of Gastroenterology and Hepatology, Shimane University, Shimane, Japan
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7666
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Uche-Anya EN, Packey CD, Khan AS, Sethi A. EUS-Guided Pancreatic Duct Puncture for Difficult Cannulation of Stenosed Pancreaticojejunostomy. Dig Dis Sci 2018; 63:268-269. [PMID: 29204744 DOI: 10.1007/s10620-017-4858-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/18/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Eugenia N Uche-Anya
- College of Physicians and Surgeons, Columbia University, New York City, NY, USA.
| | - Christopher D Packey
- Digestive and Liver Disease, New York Presbyterian, Columbia University Medical Center, New York City, NY, USA
| | - Ali S Khan
- Digestive and Liver Disease, New York Presbyterian, Columbia University Medical Center, New York City, NY, USA
| | - Amrita Sethi
- Digestive and Liver Disease, New York Presbyterian, Columbia University Medical Center, New York City, NY, USA
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7667
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Tyberg A, Saumoy M, Sequeiros EV, Giovannini M, Artifon E, Teoh A, Nieto J, Desai AP, Kumta NA, Gaidhane M, Sharaiha RZ, Kahaleh M. EUS-guided Versus Percutaneous Gallbladder Drainage: Isn't It Time to Convert? J Clin Gastroenterol 2018; 52:79-84. [PMID: 28009687 DOI: 10.1097/MCG.0000000000000786] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Endoscopic ultrasound-guided drainage (EUS-GLB) is a minimally invasive option for patients with cholecystitis who are poor surgical candidates. Compared with percutaneous drainage (PC-GLB), earlier studies have demonstrated similar efficacy with improved quality of life. We present a multicenter, international experience comparing PC-GLB and EUS-GLB in nonsurgical patients with cholecystitis. METHODS All patients who underwent either PC-GLB drainage or EUS-GLB drainage from 7 centers between January 2010 and December 2015 were included. Technical success was defined as successful placement of a catheter or stent into the gallbladder. Clinical success was defined as resolution of clinical symptoms after intervention. Adverse events, length of stay, and the need for repeat interventions and/or hospitalizations were recorded for all patients. RESULTS A total of 155 patients were included (mean age 74±14.24 y; range, 31 to 96; 56% male). Forty-two patients underwent EUS-GLB and 113 patients underwent PC-GLB. Technical success was achieved in 40 patients (95%) in the EUS-GLB group and 112 patients (99%) in the PC-GLB group (P=0.179). Clinical success was achieved in 40 patients (95%) in the EUS-GLB group and 97 patients (86%) in the PC-GLB group (P=0.157). There was no difference in hospital readmission rates between the 2 groups (14% vs. 24%; P=0.194). However, there was significantly higher number of patients requiring repeat interventions in the PC-GLB group (n=28, 24%) compared with the EUS-GLB group (n=4, 10%) (P=0.037). There was no difference in adverse events between the 2 groups. CONCLUSIONS EUS-GLB is safe and efficacious, with comparable technical and clinical success rates and no difference in adverse events. In addition, EUS-GLB offers a potential cost-saving benefit and morbidity benefit by demonstrating a decreased number of repeat interventions.
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7668
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Kim SB, Lee SH, Jeong DE, Kim KO, Gu MJ. Esophageal Basaloid Squamous Carcinoma Treated by Endoscopic Resection and Radiation. Korean J Gastroenterol 2018; 72:258-261. [DOI: 10.4166/kjg.2018.72.5.258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Sung Bum Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Si Hyung Lee
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Da Eun Jeong
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyeong Ok Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Mi Jin Gu
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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7669
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Affiliation(s)
- Jason Samarasena
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, CA, USA
| | - Kenneth J Chang
- H. H. Chao Comprehensive Digestive Disease Center, University of California, Irvine, CA, USA
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7670
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Rosenqvist K, Sheikhi R, Nyman R, Rorsman F, Sangfelt P, Ebeling Barbier C. Transjugular intrahepatic portosystemic shunt treatment of variceal bleeding in an unselected patient population. Scand J Gastroenterol 2018; 53:70-75. [PMID: 28990812 DOI: 10.1080/00365521.2017.1386795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate transjugular intrahepatic portosystemic shunt (TIPS) in variceal bleeding in a clinical setting. MATERIALS AND METHODS Retrospective review of 131 patients (116 with liver cirrhosis) treated with TIPS with covered stent grafts in a single centre from 2002 to 2016. RESULTS Survival at 1 and 2 years was 70% and 57% in patents with, and 100% at 2 years in patients without liver cirrhosis, respectively. A high Child-Pugh score and severe hepatic encephalopathy (HE) within 12 months post-TIPS were related to increased mortality. Re-bleeding occurred in 8% within 12 months and was related to TIPS dysfunction and a post-TIPS portosystemic gradient (PSG) of ≥5 mmHg. The main cause of TIPS dysfunction was that the stent did not fully reach the inferior vena cava. There was no correlation between the PSG and the occurrence of HE. CONCLUSIONS TIPS was safe and prevented re-bleeding in patients with variceal bleeding, with or without liver cirrhosis, regardless of Child-Pugh class and of how soon after bleeding onset, the TIPS procedure was performed. A post-TIPS PSG of ≥5 mmHg was associated with an increased risk for re-bleeding and there was no correlation between the post-TIPS PSG and the occurrence of HE.
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Affiliation(s)
- K Rosenqvist
- a Department of Radiology, Institution of Surgical Science, Uppsala University Hospital , Uppsala , Sweden
| | - R Sheikhi
- b Department of Hepatology, Institution of Medical Science, Uppsala University Hospital , Uppsala , Sweden
| | - R Nyman
- a Department of Radiology, Institution of Surgical Science, Uppsala University Hospital , Uppsala , Sweden
| | - F Rorsman
- b Department of Hepatology, Institution of Medical Science, Uppsala University Hospital , Uppsala , Sweden
| | - P Sangfelt
- b Department of Hepatology, Institution of Medical Science, Uppsala University Hospital , Uppsala , Sweden
| | - C Ebeling Barbier
- a Department of Radiology, Institution of Surgical Science, Uppsala University Hospital , Uppsala , Sweden
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7671
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Caetano BFR, Tablas MB, Pereira NEF, de Moura NA, Carvalho RF, Rodrigues MAM, Barbisan LF. Capsaicin reduces genotoxicity, colonic cell proliferation and preneoplastic lesions induced by 1,2-dimethylhydrazine in rats. Toxicol Appl Pharmacol 2018; 338:93-102. [DOI: 10.1016/j.taap.2017.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/20/2017] [Accepted: 11/10/2017] [Indexed: 02/07/2023]
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7672
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Gugig R, Muñoz Jurado G, Huang C, Oleas R, Robles-Medranda C. Self-expandable metal stent placement in a child for treatment of achalasia after failed Heller myotomy. Endosc Int Open 2018; 6:E64-E66. [PMID: 29344561 PMCID: PMC5770269 DOI: 10.1055/s-0043-118745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 07/24/2017] [Indexed: 11/29/2022] Open
Abstract
Background and study aims Childhood achalasia treatment remains inconclusive. What is next after myotomy failure? Repeated pneumatic-dilation put patients at greater risk of perforation with possible symptom recurrence. We report on a 12-year-old patient with a 1-year history of achalasia whom underwent Heller myotomy with fundoplication and recurred with symptoms 1 week after surgery. Pneumatic dilatation was considered but not done because of the risk of esophageal perforation. The decision was made to place a fully covered self-expanding metallic stent (FC-SEMS) for 3 months, which resolved the stenosis as confirmed by esophagram. The patient has remained asymptomatic since the procedure was performed 2 years ago. FC-SEMS is an alternative for treatment of refractory achalasia in children who do not respond to conventional treatment.
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Affiliation(s)
- Roberto Gugig
- University of California San Francisco and Valley Children’s Healthcare, San Francisco, California, United States
| | - Guillermo Muñoz Jurado
- Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil, Ecuador
| | - Clifton Huang
- University of California San Francisco and Valley Children’s Healthcare, San Francisco, California, United States
| | - Roberto Oleas
- Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil, Ecuador
| | - Carlos Robles-Medranda
- Instituto Ecuatoriano de Enfermedades Digestivas, University Hospital OMNI, Guayaquil, Ecuador,Corresponding author Carlos Robles-Medranda IECED, Omni HospitalAv. Abel R Castillo y Av. Juan Tanca Marengo s/n, Ciudad del Sol, Office Mezanine 3090505, Guayaquil, GuayasEcuador+59342109180
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7673
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Abstract
Endoscopic ultrasound has become an essential tool in modern gastroenterology and abdominal surgery. Compared with all other endoscopic methods, it has the most potential for innovation and its future looks bright. Thus, we compiled this summary of established and novel applications of endoscopic ultrasound methods to inform the reader about what is already possible and where future developments will lead in improving patient care further. This review is structured in four parts. The first section reports on developments in diagnostic endoscopic ultrasound, the second looks at semi-invasive endoscopic ultrasound, and the third discusses advances in therapeutic endoscopic ultrasound. An overview on the future prospects of endoscopic ultrasound methods concludes this article.
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Affiliation(s)
- Michael Hocke
- Internal Medicine II, Helios Hospital Meiningen, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals, Oxford, UK
| | | | - Christoph F. Dietrich
- Medical Department 2, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany
- Correspondence to Christoph F. Dietrich, M.D. Medical Department 2, Caritas Hospital Bad Mergentheim, Uhlandstraße 7, Bad Mergentheim 97980, Germany Tel: +49-7931-582201 Fax: +49-7931-582290 E-mail:
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7674
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Zahra S, Sammut M, Debono J. Phytobeozar large bowel obstruction – The prickly pear (A single centre experience and case series report). International Journal of Surgery Open 2018; 13:10-14. [DOI: 10.1016/j.ijso.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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7675
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Zhang Y, Liu Y, Zhang J, Wu X, Ji X, Fu T, Li Z, Wu Q, Bu Z, Ji J. Construction and external validation of a nomogram that predicts lymph node metastasis in early gastric cancer patients using preoperative parameters. Chin J Cancer Res 2018; 30:623-632. [PMID: 30700931 PMCID: PMC6328510 DOI: 10.21147/j.issn.1000-9604.2018.06.07] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective To create a nomogram to predict the incidence of lymph node metastasis (LNM) in early gastric cancer (EGC) patients and to externally validate the nomogram. Methods To construct the nomogram, we retrospectively analyzed a primary cohort of 272 EGC patients. Univariate analysis and a binary logistic regression were performed. A nomogram predicting the incidence of LNM in EGC patients was created. The discrimination ability of the nomogram was measured using the concordance index (c-index), and the nomogram was also calibrated. Then, another prospective cohort of 81 patients was analyzed to validate the nomogram. Results In the primary cohort, LNM was pathologically confirmed in 37 (13.6%) patients. In multivariate analysis, the presence of an ulcer, the maximum lesion diameter observed via gastroscopy, the thickness of the lesion observed via endoscopic ultrasonography, and the presence of enlarged lymph nodes on computed tomography (CT) were independent risk factors for LNM. A nomogram was then created based on the regression model with the c-index of 0.905, and the calibration curve of the nomogram fell approximately on the ideal 45-degree line. The cut-off score of the nomogram was 110, and the sensitivity, specificity, positive predictive and negative predictive values of the nomogram in the primary cohort were 81.1%, 86.0%, 47.6% and 96.7%, respectively, and in the prospective validation cohort were 75.0%, 91.0%, 60.0% and 95.5%, respectively. The calibration curve of the external validation cohort was almost on the 45-degree line. Conclusions We developed an effective nomogram predicting the incidence of LNM for EGC patients.
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Affiliation(s)
- Yinan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Gastrointestinal Cancer Center
| | | | - Ji Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Gastrointestinal Cancer Center
| | - Xiaojiang Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Gastrointestinal Cancer Center
| | - Xin Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Gastrointestinal Cancer Center
| | - Tao Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Gastrointestinal Cancer Center
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Gastrointestinal Cancer Center
| | - Qi Wu
- Endoscopy Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Zhaode Bu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Gastrointestinal Cancer Center
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), 1Gastrointestinal Cancer Center
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7676
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Abu-El-Haija M, Kumar S, Quiros JA, Balakrishnan K, Barth B, Bitton S, Eisses JF, Foglio EJ, Fox V, Francis D, Freeman AJ, Gonska T, Grover AS, Husain SZ, Kumar R, Lapsia S, Lin T, Liu QY, Maqbool A, Sellers ZM, Szabo F, Uc A, Werlin SL, Morinville VD. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr 2018; 66:159-76. [PMID: 29280782 DOI: 10.1097/MPG.0000000000001715] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the incidence of acute pancreatitis (AP) in children is increasing, management recommendations rely on adult published guidelines. Pediatric-specific recommendations are needed. METHODS The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas committee performed a MEDLINE review using several preselected key terms relating to management considerations in adult and pediatric AP. The literature was summarized, quality of evidence reviewed, and statements of recommendations developed. The authorship met to discuss the evidence, statements, and voted on recommendations. A consensus of at least 75% was required to approve a recommendation. RESULTS The diagnosis of pediatric AP should follow the published INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE definitions (by meeting at least 2 out of 3 criteria: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings consistent with AP). Adequate fluid resuscitation with crystalloid appears key especially within the first 24 hours. Analgesia may include opioid medications when opioid-sparing measures are inadequate. Pulmonary, cardiovascular, and renal status should be closely monitored particularly within the first 48 hours. Enteral nutrition should be started as early as tolerated, whether through oral, gastric, or jejunal route. Little evidence supports the use of prophylactic antibiotics, antioxidants, probiotics, and protease inhibitors. Esophago-gastro-duodenoscopy, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography have limited roles in diagnosis and management. Children should be carefully followed for development of early or late complications and recurrent attacks of AP. CONCLUSIONS This clinical report represents the first English-language recommendations for the management of pediatric AP. Future aims should include prospective multicenter pediatric studies to further validate these recommendations and optimize care for children with AP.
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7677
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Sheiybani G, Brydon P, Toolan M, Linehan J, Farrant M, Colleypriest B. Does rectal diclofenac reduce post-ERCP pancreatitis? A district general hospital experience. Frontline Gastroenterol 2018; 9:73-77. [PMID: 29484164 PMCID: PMC5824769 DOI: 10.1136/flgastro-2017-100832] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/08/2017] [Accepted: 07/03/2017] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION There is controversy in the literature recently regarding the efficacy of rectal non-steroidal anti-inflammatory drugs (NSAID) to prevent post-ERCP pancreatitis (PEP). The aim of this study was to compare the incidence of PEP in three distinct groups of patients at the Royal United Hospital, Bath: no use of rectal diclofenac, selective use and blanket use without contraindication. METHOD Readmission data, blood results, radiology reports and discharge summaries were used to identify patients with PEP from August 2010 to December 2015. The administration of rectal diclofenac postprocedure was recorded from the endoscopy reporting system. RESULTS 1318 endoscopic retrograde cholangiopancreatographies (ERCP) were performed by four endoscopists during the study period with 66 (5.0%) cases of pancreatitis. 445 ERCPs were performed prior to the introduction of NSAID use during which time, with an incidence of 35 (7.9%) episodes of PEP. During the selective period of NSAID use (high-risk patients) 539 ERCPs were performed and 72 (13.4%) patients received NSAIDs. 17 (3.2%) developed PEP. 334 ERCPs were performed when NSAIDs were given to all patients without contraindication. 289 (86.5%) of patients received rectal diclofenac and 13 (3.9%) developed pancreatitis. There is a statistically significant decrease in PEP comparing the groups of patients receiving NSAIDs selectively (p=0.0009) or routinely (p=0.0172) when compared with none. There is no difference between the selective and routine group (p=0.571). CONCLUSION Our data demonstrate that the introduction of a selective or routine use of NSAIDs for PEP in a District General Hospital (DGH) significantly decreases the risk of pancreatitis (risk reduction 43.7%).
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Affiliation(s)
| | - Peter Brydon
- Gastroenterology, Royal United Hospital, Bath, UK
| | | | - John Linehan
- Gastroenterology, Royal United Hospital, Bath, UK
| | - Mark Farrant
- Gastroenterology, Royal United Hospital, Bath, UK
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7678
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Affiliation(s)
- Sun-Jin Boo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Heung Up Kim
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
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7679
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Ge N, Hu J, Sun S, Linghu E, Jin Z, Li Z. Endoscopic Ultrasound-guided Pancreatic Pseudocyst Drainage with Lumen-apposing Metal Stents or Plastic Double-pigtail Stents: A Multifactorial Analysis. J Transl Int Med 2017; 5:213-219. [PMID: 29340278 DOI: 10.1515/jtim-2017-0036] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. Method Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. Results There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement. The total rate of technical success was 100%. The total rate of clinical success was 100%. The total rate of adverse events was 7.7% (4/52). On multiple logistic regression analysis, the use of plastic stents (P < 0.05, Exp B = 12.168) and the presence of a large cyst (P < 0.05, Exp B = 1.036) were shown to significantly increase the risk of reintervention. On multivariate linear regression analysis, etiology of pseudocyst (P < 0.05, B = -8.427, -9.785, -5.514) was associated with prolonged hospital stent, while stent type was not shown be a factor (P > 0.05). Conclusion Both plastic and LAMSs are proven to be highly efficient in PP drainage. The LAMS is superior in preventing complications such as migration and cyst leakage and reducing the rate of reintervention.
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Affiliation(s)
- Nan Ge
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Jinlong Hu
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Siyu Sun
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
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7680
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Kim BG, Moon JY, Choi JY, Park IS, Oh AY, Jeon YT, Hwang JW, Ryu JH. The Effect of Intraoperative Nefopam Administration on Acute Postoperative Pain and Chronic Discomfort After Robotic or Endoscopic Assisted Thyroidectomy: A Randomized Clinical Trial. World J Surg 2017; 42:2094-2101. [DOI: 10.1007/s00268-017-4421-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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7681
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Ge N, Hu J, Sun S, Linghu E, Jin Z, Li Z. Endoscopic Ultrasound-guided Pancreatic Pseudocyst Drainage with Lumen-apposing Metal Stents or Plastic Double-pigtail Stents: A Multifactorial Analysis. J Transl Int Med 2017. [PMID: 29340278 DOI: 10.1515/jtim-2017-0036.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare the efficiency of plastic and metal stents for symptomatic pancreatic pseudocyst (PP) drainage and analyze other main associated factors that affect the outcome of drainage therapy. Method Rates of technical and clinical success, procedure-related side effects (hemorrhage, stent migration, and cyst rupture), reinterventions, and duration of hospital stay. Results There were 52 patients, 40 patients underwent plastic stent placement and 12 patients underwent lumen-apposing metal stent (LAMS) placement. The total rate of technical success was 100%. The total rate of clinical success was 100%. The total rate of adverse events was 7.7% (4/52). On multiple logistic regression analysis, the use of plastic stents (P < 0.05, Exp B = 12.168) and the presence of a large cyst (P < 0.05, Exp B = 1.036) were shown to significantly increase the risk of reintervention. On multivariate linear regression analysis, etiology of pseudocyst (P < 0.05, B = -8.427, -9.785, -5.514) was associated with prolonged hospital stent, while stent type was not shown be a factor (P > 0.05). Conclusion Both plastic and LAMSs are proven to be highly efficient in PP drainage. The LAMS is superior in preventing complications such as migration and cyst leakage and reducing the rate of reintervention.
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Affiliation(s)
- Nan Ge
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Jinlong Hu
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Siyu Sun
- Endoscopy center, Shengjing Hospital of China Medical University, Shenyang110004, Liaoning Province, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing, China
| | - Zhendong Jin
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Zhaoshen Li
- Department of Gastroenterology, Changhai Hospital, the Second Military Medical University, Shanghai, China
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7682
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Dubois H, Schmidt PT, Creutzfeldt J, Bergenmar M. Person-centered endoscopy safety checklist: Development, implementation, and evaluation. World J Gastroenterol 2017; 23:8605-8614. [PMID: 29358869 PMCID: PMC5752721 DOI: 10.3748/wjg.v23.i48.8605] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/27/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe the development and implementation of a person-centered endoscopy safety checklist and to evaluate the effects of a “checklist intervention”.
METHODS The checklist, based on previously published safety checklists, was developed and locally adapted, taking patient safety aspects into consideration and using a person-centered approach. This novel checklist was introduced to the staff of an endoscopy unit at a Stockholm University Hospital during half-day seminars and team training sessions. Structured observations of the endoscopy team’s performance were conducted before and after the introduction of the checklist. In addition, questionnaires focusing on patient participation, collaboration climate, and patient safety issues were collected from patients and staff.
RESULTS A person-centered safety checklist was developed and introduced by a multi-professional group in the endoscopy unit. A statistically significant increase in accurate patient identity verification by the physicians was noted (from 0% at baseline to 87% after 10 mo, P < 0.001), and remained high among nurses (93% at baseline vs 96% after 10 mo, P = nonsignificant). Observations indicated that the professional staff made frequent attempts to use the checklist, but compliance was suboptimal: All items in the observed nurse-led “summaries” were included in 56% of these interactions, and physicians participated by directly facing the patient in 50% of the interactions. On the questionnaires administered to the staff, items regarding collaboration and the importance of patient participation were rated more highly after the introduction of the checklist, but this did not result in statistical significance (P = 0.07/P = 0.08). The patients rated almost all items as very high both before and after the introduction of the checklist; hence, no statistical difference was noted.
CONCLUSION The intervention led to increased patient identity verification by physicians - a patient safety improvement. Clear evidence of enhanced person-centeredness or team work was not found.
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Affiliation(s)
- Hanna Dubois
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
| | - Peter T Schmidt
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm 17177, Sweden
| | - Johan Creutzfeldt
- Center for Advanced Medical Simulation and Training, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm 17177, Sweden
| | - Mia Bergenmar
- Center for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm 17176, Sweden
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7683
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Abstract
Cholangitis is a serious life-threatening situation affecting the hepatobiliary system. This review provides an update regarding the clinical and pathological features of various forms of cholangitis. A comprehensive search was performed in the PubMed, Scopus, and Web of Knowledge databases. It was found that the etiology and pathogenesis of cholangitis are heterogeneous. Cholangitis can be categorized as primary sclerosing (PSC), secondary (acute) cholangitis, and a recently characterized form, known as IgG4-associated cholangitis (IAC). Roles of genetic and acquired factors have been noted in development of various forms of cholangitis. PSC commonly follows a chronic and progressive course that may terminate in hepatobiliary neoplasms. In particular, PSC commonly has been associated with inflammatory bowel disease. Bacterial infections are known as the most common cause for AC. On the other hand, IAC has been commonly encountered along with pancreatitis. Imaging evaluation of the hepatobiliary system has emerged as a crucial tool in the management of cholangitis. Endoscopic retrograde cholangiography, magnetic resonance cholangiopancreatography and endoscopic ultrasonography comprise three of the modalities that are frequently exploited as both diagnostic and therapeutic tools. Biliary drainage procedures using these methods is necessary for controlling the progression of cholangitis. Promising results have been reported for the role of antibiotic treatment in management of AC and PSC; however, immunosuppressive drugs have also rendered clinical responses in IAC. With respect to the high rate of complications, surgical interventions in patients with cholangitis are generally restricted to those patients in whom other therapeutic approaches have failed.
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7684
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Kappelle WFW, Backes Y, Valk GD, Moons LMG, Vleggaar FP. Endoscopic full-thickness resection of gastric and duodenal subepithelial lesions using a new, flat-based over-the-scope clip. Surg Endosc 2017; 32:2839-2846. [PMID: 29282573 PMCID: PMC5956064 DOI: 10.1007/s00464-017-5989-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 04/27/2017] [Accepted: 11/19/2017] [Indexed: 02/06/2023]
Abstract
Background Surgical resection of upper gastrointestinal (GI) subepithelial tumors (SETs) is associated with significant morbidity and mortality. A new over-the-scope (OTS) clip can be used for endoscopic full-thickness resection (eFTR). We aimed to prospectively evaluate feasibility and safety of upper GI eFTR with a new, flat-based OTS clip. Methods Consecutive patients with a gastric or duodenal SET < 20 mm were prospectively included. After identification of the lesion, the clip was placed and lesions were resected. Patients were followed for 1 month to assess severe adverse events (SAEs); 3–6 months after eFTR, endoscopy was performed. Results eFTR was performed on 13 lesions in 12 patients: 7 gastric and 6 duodenal SETs. Technical success was achieved in 11 cases (85%). In all 11 cases, R0-resection was achieved. In all 6 duodenal cases and in one gastric case, FTR was achieved (64%). One SAE (pain) was observed after eFTR of a gastric SET. After eFTR of duodenal SETs, several SAEs were observed: perforation (n = 1), microperforation (n = 3), and hemorrhage (n = 1). During follow-up endoscopy, the clip was no longer in situ in most patients (7 of 10; 70%). Conclusions eFTR with this new flat-based OTS clip is feasible and effective. Although gastric eFTR was safe, eFTR in the duodenum was complicated by (micro)perforation in several patients. Therefore, the design of the clip or the technique of resection needs further refinement to improve safety of resection of SET in thin-walled areas such as the duodenum before being applied in clinical practice. Dutch trial register: NTR5023. Electronic supplementary material The online version of this article (10.1007/s00464-017-5989-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wouter F W Kappelle
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, P. O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Yara Backes
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, P. O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Gerlof D Valk
- Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, P. O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, P. O. Box 85500, 3508 GA, Utrecht, The Netherlands
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7685
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Kim SJ, Choi CW, Kang DH, Kim HW, Park SB, Nam HS, Ryu DG. Preoperative predictors of beyond endoscopic submucosal dissection indication or lymphovascular invasion in endoscopic resection for early gastric cancer. Surg Endosc 2018; 32:2948-57. [PMID: 29280013 DOI: 10.1007/s00464-017-6009-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/06/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND To successfully resect early gastric cancer (EGC), prediction of lymph node metastasis is essential. Beyond endoscopic submucosal dissection (ESD) indication or lymphovascular invasion (LVI) are known risk factors associated with lymph node metastasis. However, accurate prediction of tumor invasion depth or LVI is impossible before endoscopic resection even when endoscopic ultrasound is used. The aim of this study was to identify the predictive factors associated with beyond ESD indication or LVI after ESD for EGC. METHODS Between Jan 2011 and Feb 2015, 532 lesions from 506 patients who received ESD for EGCs were included. We reviewed the data of patients diagnosed as EGCs without ulceration or those smaller than 3 cm with ulceration. RESULTS The incidence of EGCs found to be beyond expanded ESD indications or present of LVI after ESD was 11.1% (59/532). On multivariable analysis, endoscopic features of SM invasion, surface color changes, and elevated lesions were associated with beyond ESD indication or LVI. In particular, submucosal (SM) invasive features such as SM tumor-like marginal elevation [odds ratio (OR) 17.2; 95% confidence interval (CI) 2.0-146.7], fusion of convergent folds (OR 12.9; 95% CI 3.9-42.1), irregular surface (OR 17.8; 95% CI 5.6-56.8), and discoloration of the tumor surface (OR 16.1; 95% CI 2.4-105.9) were significant risk factors for beyond ESD indication or LVI. CONCLUSIONS The decision to proceed with endoscopic resection for EGCs with endoscopic features of SM invasion, surface color changes, or elevated forms must be made cautiously.
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7686
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Abstract
BACKGROUND Cholangiocarcinoma has poor prognosis and short term-survival. Here, we report the case of a patient with unusually prolonged survival. CASE PRESENTATION Our patient was a 56-year-old Arab man with a 6-month history of obstructive jaundice. A computed tomography scan of his abdomen revealed a mass at the confluence of the hepatic ducts with suspected malignant strictures on endoscopy. A positive tissue diagnosis was achieved more than 18 months after commencement of his symptoms. He remained functional throughout this period despite recurrent episodes of cholangitis. CONCLUSIONS Cholangiocarcinoma is a presumably fatal disease, especially because patients tend to present late with unresectable disease. Many patient-related and disease-related factors may alter survival.
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Affiliation(s)
- Mohammed Z Al-Zahir
- Department of Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Turki AlAmeel
- Department of Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.
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7687
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Al Moussawi H, Al Khatib M, El Ahmar M, Al Masri H, Leddy A, Akel T, Khalil A. The effect of premedication with peppermint oil capsules (Colpermin) prior to colonoscopy: A double blind randomized placebo-controlled trial. Arab J Gastroenterol 2017; 18:220-3. [PMID: 29273467 DOI: 10.1016/j.ajg.2017.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 04/18/2017] [Revised: 10/26/2017] [Accepted: 12/04/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND STUDY AIMS Colonoscopy is the cornerstone of diagnosing colonic diseases. Investigators have evaluated the effectiveness of antispasmodic agents in colonoscopy with conflicting evidence. The aim of this study is to determine the efficacy of enteric coated peppermint oil capsules (Colpermin®), an antispasmodic agent, on outcomes during colonoscopy. PATIENTS AND METHODS A total of 80 patients undergoing elective colonoscopy were recruited and randomized in a double blinded fashion to receive either placebo or peppermint oil capsules administered 4 h prior to the procedure. RESULTS Peppermint oil capsules did not affect caecal intubation time when compared with placebo. Patients' tolerance, endoscopist's satisfaction and demand on sedation were also not affected. CONCLUSION This randomized controlled trial does not support the routine use of peppermint oil capsules prior to colonoscopy as a tool for procedure optimization, and patients' and endoscopist's satisfaction.
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7688
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Raffenne J, Cros J. [Molecular characterisation defines several subtypes of pancreatic ductal adenocarcinoma]. Bull Cancer 2017; 105:55-62. [PMID: 29273547 DOI: 10.1016/j.bulcan.2017.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/31/2017] [Accepted: 11/08/2017] [Indexed: 02/04/2023]
Abstract
Multi-omics high throughput analyses lead to the description of multiple molecular subtypes of pancreatic adenocarcinoma with major prognostic impact for most of them. There is no consensual multilevel integrative classification yet like in colon or breast cancers. Genomic classifications have identified a tumor subtype (15% of the patients) with deficient homologous DNA repair-system leading to increase sensitivity to platinum-based therapies and possibly to PARP inhibitors and immunotherapies. Transcriptomic classifications are still debated but all have identified an aggressive subtype with a very poor prognosis, presumably unfit for a surgical approach. Finally, approaches based on metabolomic or proteomic profiling have identified subtypes with a particular sensitivity to compounds targeting the hallmarks metabolomics or oncogenic pathways of each subtype. These classifications were mostly based on tumor cell but the micro-environment is also very heterogeneous and several types of stroma will be described soon. Subtype determination in daily practice remains a major challenge as most technologies used to build these classifications are very expensive, requires dedicated bio-informatics analysis pipelines and are not adapted to routine samples that are mostly formal in fixed paraffin embedded biopsies, in which tumor cells are highly contaminated by the cell from the microenvironment and the clot.
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Affiliation(s)
- Jérôme Raffenne
- Faculté de médecine Paris-Diderot Paris 7 - site Bichat, centre de recherche sur l'inflammation, Inserm-U1149, 16, rue Henri-Huchard, 75890 Paris cedex 18, France
| | - Jérôme Cros
- Faculté de médecine Paris-Diderot Paris 7 - site Bichat, centre de recherche sur l'inflammation, Inserm-U1149, 16, rue Henri-Huchard, 75890 Paris cedex 18, France; Hôpital Beaujon, service de pathologie, 92110 Clichy, France.
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7689
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de la Morena Madrigal EJ, Rodríguez García MªI, Galera Ródenas AB, Pérez Arellano E. Biliary cannulation effectiveness and pancreatitis risk using two early precut techniques. Rev Esp Enferm Dig 2017; 110:74-81. [PMID: 29271219 DOI: 10.17235/reed.2017.5175/2017] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Precut techniques allow for successful biliary cannulation rates approaching 100% but there may be an associated increase in the risk of complications. Recently, early needle-knife precut has been shown to be a safe procedure and is now used as a pancreatitis prevention resource for difficult cannulation cases. The goal of the present study was to assess cannulation and pancreatitis rates using two early precut techniques. PATIENTS AND METHODS This was a retrospective study of endoscopic retrograde cholangio-pancreatography (ERCP) procedures performed from 2013 to 2016. The efficacy and safety of simple cannulation, needle-knife precut and transpancreatic precut were assessed. RESULTS Simple cannulation was achieved in 369 (73.4%) of 503 evaluable ERCP procedures. Needle-knife precut was successful in 51 (96.2%) of 53 attempts and transpancreatic precut was successful in 75 (96.2%) of 78 attempts. The overall cannulation rate was 98.4%. There were eleven (2.4%) pancreatitis events, six (1.8%) with simple cannulation (two severe, one fatal), five (6.3%) with transpancreatic precut (two severe) and zero events with the needle-knife precut procedure. Among the patients undergoing the precut procedure, seven experienced perforations (two severe) and there were seven bleeding events. The overall complication rate was 14.4%. CONCLUSIONS The complementary use of either precut technique provides a satisfactory biliary cannulation rate. However, the rates of pancreatitis and other severe complications are higher for transpancreatic versus needle-knife precut, therefore the indications for both techniques should be modified.
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7690
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Ishido K, Tanabe S, Azuma M, Katada C, Wada T, Yano T, Koizumi W. Comparison of oral and intravenous lansoprazole for the prevention of bleeding from artificial ulcers after endoscopic submucosal dissection for gastric tumors: a prospective randomized phase II study (KDOG 0802). Surg Endosc 2018; 32:2939-47. [PMID: 29273872 DOI: 10.1007/s00464-017-6008-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/06/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Very few studies have evaluated the effectiveness of oral proton-pump inhibitors for the prevention of bleeding after endoscopic submucosal dissection (ESD) for gastric tumors. The aim of our study was to establish the non-inferiority of lansoprazole orally disintegrating (OD) tablets to intravenous lansoprazole for the prevention of bleeding from artificial ulcers after ESD. PATIENTS AND METHODS Consecutive patients who underwent ESD for gastric tumors were randomly assigned to receive lansoprazole OD tablets (OD group) or intravenous lansoprazole (IV group). In the OD group, lansoprazole OD tablets (30 mg) were given orally once daily for 8 weeks (56 days), starting on the day before ESD. In the IV group, lansoprazole (30 mg) was given as a continuous intravenous infusion twice daily for 3 days, starting on the day before ESD, and lansoprazole OD tablets (30 mg) were given orally once daily on days 4-56. The primary endpoint was the incidence of bleeding events within 8 weeks after ESD. RESULTS Among 310 enrolled patients, 304 patients (152 in the OD group and 152 in the IV group) were included in the analysis. Endoscopic hemostasis was performed in 38 patients (19 in the OD group and 19 in the IV group). The incidence of bleeding events within 8 weeks after ESD did not differ significantly between the groups (p = 0.487). Endoscopic hemostasis was performed at second-look endoscopy in 17 patients (11.2%) in the OD group and 19 patients (12.5%) in the IV group (difference, 1.3 percentage points; 90% confidence interval, - 4.8-7.4%; non-inferiority, p < 0.001). CONCLUSIONS The effectiveness of lansoprazole OD tablets for the prevention of bleeding from artificial ulcers after ESD was similar to that of intravenous lansoprazole. Lansoprazole OD tablets are thus considered a treatment option in patients who undergo ESD.
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7691
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Serra-aracil X, Gálvez A, Mora-lópez L, Rebasa P, Serra-pla S, Pallisera-lloveras A, Zerpa C, Moreno O, Navarro-soto S. Endorectal ultrasound in the identification of rectal tumors for transanal endoscopic surgery: factors influencing its accuracy. Surg Endosc 2018; 32:2831-8. [DOI: 10.1007/s00464-017-5988-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023]
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7692
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Ribeiro da Silva J, Proença L, Rodrigues A, Pinho R, Ponte A, Rodrigues J, Sousa M, Almeida R, Carvalho J. Intragastric Balloon for Obesity Treatment: Safety, Tolerance, and Efficacy. GE Port J Gastroenterol 2017; 25:236-242. [PMID: 30320162 DOI: 10.1159/000485428] [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] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/14/2017] [Indexed: 12/15/2022]
Abstract
Background Obesity is an increasing worldwide problem associated with a vast number of comorbidities. Decreasing body weight by only 5-10% has been shown to slow and even prevent the onset of obesity-related comorbidities. Between pharmacological therapy and bariatric surgery a great variety of endoscopic techniques are available, the most common being intragastric balloon (IGB). The purpose of this study was to assess the safety, tolerance, and kinetics of IGBs in weight loss. The kinetics of weight loss were evaluated in 2 different contexts and phases: after the IGB's removal and after follow-up that varied between 6 and 12 months. Successful weight loss was defined as ≥10% weight loss after 6-12 months. Methods The study included 51 patients who had undergone Orbera® IGB placement between September 2014 and February 2016. Inclusion criteria were age between 18 and 65 years; body mass index (BMI) 28-35 with severe obesity-related disorders; or BMI 35-40. The IGB was removed 6 months later. All patients were followed for a minimum period of 6-12 months. Results Of 51 patients, 16 were excluded (7 due to intolerance) and 35 patients entered the study, of which 83% were followed for more than 6-12 months. The average weight loss (WL) and % excess WL (%EWL) after 6 months of treatment were 11.94 kg and 42.16%, respectively. At 6-12 months, after removal of the IGB, the mean WL was 8.25 kg and %EWL was 30.27%. Nineteen patients attained a WL of ≥10% the baseline value at IGB removal and 12 maintained their weight below this threshold during the 6-12 following months. Conclusions After temporary IGB implantation in overweight or obese individuals, a WL that was ≥10% of weight at baseline was achieved in 54.3% and sustained at 6-12 months in 41.4% of participants. IGBs are an attractive intermediate option between diet and exercise programs and bariatric surgery. In general, IGB placement is a safe and well-tolerated procedure.
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Affiliation(s)
- Joana Ribeiro da Silva
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Luísa Proença
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Adélia Rodrigues
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rolando Pinho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ana Ponte
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Jaime Rodrigues
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Mafalda Sousa
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Rita Almeida
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - João Carvalho
- Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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7693
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Ivano FH, Villela IR, Miranda LFD, Nakadomari TS. ANALYSIS OF DOUBLE BALLOON ENTEROSCOPY: INDICATIONS, FINDINGS, THERAPEUTIC AND COMPLICATIONS. Arq Bras Cir Dig 2017; 30:83-87. [PMID: 29257840 PMCID: PMC5543783 DOI: 10.1590/0102-6720201700020002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 09/13/2016] [Indexed: 12/22/2022]
Abstract
Background: The double balloon enteroscopy is an important method for the endoscopic approach of the small bowel that provides diagnosis and therapy of this segment’s disorders, with low complication rate. Aim: Analysis of patients undergoing double balloon enteroscopy. The specific objectives were to establish the indications for this method, evaluate the findings by the double balloon enteroscopy, analyze the therapeutic options and the complications of the procedure. Methods: It is a retrospective analysis of 65 patients who underwent double balloon enteroscopy. Results: Sixty-five procedures were performed in 50 patients, 63.1% were women and 36.9% were men. The mean age was 50.94 years. The main indication it was gastrointestinal bleeding, followed by abdominal pain and Crohn’s disease. Most procedures were considered normal. Polyps were the most prevalent finding, followed by angioectasias and duodenitis. In 49.2% of the cases, one or more therapeutic procedures were performed, (biopsy was the most prevalent). There was only one case of acute pancreatitis, which was treated clinically. Conclusion: The enteroscopy is good and safe method for the evaluation of the small bowel, and its main indications are gastrointestinal bleeding and abdominal pain. It has low complications rates and reduces the necessity of surgery.
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Affiliation(s)
- Flávio Heuta Ivano
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| | - Izabela Rodrigues Villela
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| | - Lívia Fouani de Miranda
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
| | - Thaísa Sami Nakadomari
- Serviço de Endoscopia, Hospital Sugisawa (Endoscopy Service, Sugisawa Hospital, Curitiba, PR, Brazil
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7694
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Beketaev I, Reardon PR, Okoye EI, Morris LM. Recurrent lower gastrointestinal bleeding in an 87-year-old woman. BMJ Case Rep 2017; 2017:bcr-2017-223601. [PMID: 29269375 DOI: 10.1136/bcr-2017-223601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Ilimbek Beketaev
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Patrick R Reardon
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Ekene I Okoye
- Clinical Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Lee M Morris
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
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7695
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Tan Y, Tan L, Lu J, Huo J, Liu D. Endoscopic resection of gastric gastrointestinal stromal tumors. Transl Gastroenterol Hepatol 2017; 2:115. [PMID: 29354772 DOI: 10.21037/tgh.2017.12.03] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [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: 11/16/2017] [Accepted: 12/04/2017] [Indexed: 12/12/2022] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, and about 60% of them are found in the stomach. With the widespread application of endoscopy and endoscopic ultrasonography (EUS), more and more gastric GISTs are being found in an early stage (with a relative small diameter and no metastasis), giving the chance of complete resection. Endoscopic resection such as endoscopic band ligation (EBL), endoscopic submucosal dissection (ESD), endoscopic submucosal excavation (ESE), endoscopic full-thickness resection (EFTR) and submucosal tunneling endoscopic resection (STER), is a minimally invasive method compared with the conventional surgical approaches (open or laparoscopic), and has been demonstrated to be safe and effective for treating gastric GISTs. This review summarizes the recent advances on endoscopic resection of gastric GISTs, aiming to provide a rational management strategy for gastric GISTs.
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Affiliation(s)
- Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Linna Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Jiaxi Lu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Jirong Huo
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
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7696
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Abstract
Colonoscopy is the gold standard for colon cancer screening. It has led to a decrease in the incidence of colorectal cancer mortality. Colon perforation is a feared complication of this procedure with high morbidity and substantial mortality. Due to the high volume of colonoscopies performed, the absolute number of colonoscopic perforations is relatively high. It leads to a substantial cost to the patient and the health system. Understanding the mechanisms and the risk factors may help in preventing perforation. Traditionally, a laparotomy with creation of a stoma was used to address this complication. However, minimally invasive techniques such as laparoscopy and endoluminal repairs are being used more commonly now. More surgeons are favoring primary anastomosis (with or without a diverting loop ileostomy) than a Hartmann procedure.
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Affiliation(s)
- Vinay Rai
- Department of Surgery, University of New Mexico, Albuquerque, New Mexico
| | - Nitin Mishra
- Division of Colon and Rectal Surgery, Mayo Clinic College of Medicine, Phoenix, Arizona
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7697
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Yung DE, Har-Noy O, Tham YS, Ben-Horin S, Eliakim R, Koulaouzidis A, Kopylov U. Capsule Endoscopy, Magnetic Resonance Enterography, and Small Bowel Ultrasound for Evaluation of Postoperative Recurrence in Crohn's Disease: Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2017; 24:93-100. [PMID: 29272490 DOI: 10.1093/ibd/izx027] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 08/08/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anastomotic recurrence is frequent in patients with Crohn's disease (CD) following ileocecal resection. The degree of endoscopic recurrence, quantified by the Rutgeerts score (RS), is correlated with the risk of clinical and surgical recurrence. Noninvasive modalities such as capsule endoscopy (CE), magnetic resonance enterography (MRE), and intestinal ultrasound (US) may yield similar information without the need for ileocolonoscopy (IC). The aim of our meta-analysis was to evaluate the accuracy of those modalities for detection of endoscopic recurrence in postoperative CD patients. METHODS We performed a systematic literature search for studies comparing the accuracy of CE, MRE, and US with IC for detection of postoperative recurrence in CD. We calculated pooled diagnostic sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) for each comparison. RESULTS A total of 135 studies were retrieved; 14 studies were eligible for analysis. For CE, the pooled sensitivity was 100% (95% CI, 91%-100%), specificity was 69% (95% CI, 52%-83%), DOR was 30.8 (95% CI, 6.9-138), and AUC was 0.94. MRE had pooled sensitivity of 97% (95% CI, 89%-100%), specificity of 84% (95% CI, 62%-96%), DOR of 129.5 (95% CI, 16.4-1024.7), and AUC of 0.98. US had pooled sensitivity of 89% (95% CI, 85%-92%), specificity of 86% (95% CI, 78%-93%), DOR of 42.3 (95% CI, 18.6-96.0), and AUC 0.93. CONCLUSIONS CE, MRE, and US provide accurate assessment of postoperative endoscopic recurrence in CD. These modalities should gain wider use for detection of postoperative recurrence; the prognostic value of those diagnostic findings merits evaluation in further prospective studies.
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Affiliation(s)
- Diana E Yung
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Ofir Har-Noy
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yuen Sau Tham
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Shomron Ben-Horin
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anastasios Koulaouzidis
- Centre for Liver and Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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7698
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Wu DX, Chen YD, Liu P. Advances in management of difficult biliary access. Shijie Huaren Xiaohua Zazhi 2017; 25:3149-3154. [DOI: 10.11569/wcjd.v25.i35.3149] [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
Since the first report of endoscopic retrograde cholangio-pancreatography (ERCP) in 1986 for the diagnosis of biliary-pancreatic disease, ERCP has become an important means for the diagnosis and treatment of biliary-pancreatic disease. At present, although the success rate of endoscopic selective biliary cannulation is more than 90%, there are still 5%-10% of cases with failed cannulation, for which assistive technology is needed as a supplementary to achieve successful cannulation. Repeated attempts correlate with a higher success rate of cannulation, but also extend the operating time and increase the incidence of complications. In recent years, the concept of difficult biliary cannulation has been put forward and gradually accepted by endoscopic physicians. In the cases of difficult biliary cannulation, endoscopic physicians can adjust the cannulation strategy in time to improve the success rate and reduce the complication rate. This paper summarizes the literature published recently to make a systematic review of the advances in the management of difficult biliary cannulation.
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Affiliation(s)
- Dong-Xia Wu
- Department of Gastroenterology, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan Province, China
| | - Ya-Dong Chen
- Department of Gastroenterology, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan Province, China
| | - Peng Liu
- Department of Gastroenterology, the First Affiliated Hospital of Hunan Normal University, Changsha 410000, Hunan Province, China
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7699
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Xia JY, Ji XL. Well-differentiated adenocarcinoma may be misdiagnosed as gastritis cystica profunda. Shijie Huaren Xiaohua Zazhi 2017; 25:3089-3093. [DOI: 10.11569/wcjd.v25.i35.3089] [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
Gastric cancer (GC) is one of the most common malignant tumors in China. The low detection rate of early GC is one of the reasons for its high mortality rate. Thanks to the application of new gastroscopy technology, the detection rate of early GC has increased. Highly differentiated adenocarcinoma accounts for about 70% of all early GC cases; however, well-differentiated adenocarcinoma is difficult to diagnose because of its non-significant structural abnormality and cellular atypia. Gastritis cystica profunda is a rare disease characterized by the presence of the gastric intrinsic gland in the muscularis mucosa and/or submucosa, which is easily confused with highly differentiated adenocarcinoma. Therefore, attention should be paid to the identification of these two different entities in the clinical work.
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Affiliation(s)
- Jing-Yuan Xia
- Department of Pathology, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China
| | - Xiao-Long Ji
- Department of Pathology, General Hospital of Chinese People's Armed Police Forces, Beijing 100039, China
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7700
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Parikh MP, Muthukuru S, Jobanputra Y, Naha K, Gupta NM, Wadhwa V, Lopez R, Thota PN, Sanaka MR. Proximal Sessile Serrated Adenomas Are More Prevalent in Caucasians, and Gastroenterologists Are Better Than Nongastroenterologists at Their Detection. Gastroenterol Res Pract 2017; 2017:6710931. [PMID: 29403530 DOI: 10.1155/2017/6710931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/04/2017] [Accepted: 11/23/2017] [Indexed: 12/16/2022] Open
Abstract
Background and Aim Proximal sessile serrated adenomas (PSSA) leading to colorectal cancer (CRC) represent an alternate pathway for CRC development. In this study, we aim to determine the prevalence of PSSAs and the impact of patient, colonoscopy, and endoscopist-related factors on PSSA detection. Methods Patients ≥ 50 years of age undergoing a screening colonoscopy between 2012 and 2014 were included. Detection rates based on patient gender, race, colonoscopy timing, fellow participation, bowel preparation quality, and specialty of the endoscopist were calculated. t-tests were used to compare detection rates and a multivariate-adjusted analysis was performed. Results 140 PSSAs were detected from 4151 colonoscopies, with a prevalence of 3.4%. Detection rate was higher in Caucasians compared to African-Americans (AA) (3.7 ± 4.1 versus 0.96 ± 3.5; p < 0.001). Gastroenterologists detected more PSSAs compared to nongastroenterologists (3.9 ± 3.5 versus 2.2 ± 3.0; p = 0.028). These findings were still significant after adjusted multivariate analysis. The rest of the factors did not make significant difference in PSSA detection rate. Conclusions PSSAs are more prevalent in Caucasians compared to AAs. Racial difference in prevalence of PSSAs is intriguing and warrants further investigation. Gastroenterologists have a significantly higher PSSADR compared to nongastroenterologists. Educational measures should be implemented in nongastroenterologists to improve their PSSA detection rates.
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