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Bicudo de Oliveira L, Funari MP, So Taa Kum A, Bestetti ADM, Brunaldi VO, Franzini TAP, Moura ETH, Baroni LM, de Carvalho MF, Bernardo WM, de Moura EGH. Pure cut vs. Endocut in endoscopic biliary sphincterotomy: Systematic review and meta-analysis of randomized clinical trials. Endosc Int Open 2024; 12:E830-E841. [PMID: 38966317 PMCID: PMC11221911 DOI: 10.1055/a-2325-3821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/12/2024] [Indexed: 07/06/2024] Open
Abstract
Background and study aims Biliary sphincterotomy is a crucial step in endoscopic retrograde cholangiopancreatography (ERCP), a procedure known to carry a 5% to 10% risk of complications. The relationship between Pure cut, Endocut, post-ERCP pancreatitis (PEP) and bleeding is unclear. This systematic review and meta-analysis compared these two current types and their relationships with adverse events. Patients and methods This systematic review involved searching articles in multiple databases until August 2023 comparing pure cut versus Endocut in biliary sphincterotomy. The meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Results A total of 987 patients from four randomized controlled trials were included. Overall pancreatitis: A higher risk of pancreatitis was found in the Endocut group than in the Pure cut group ( P =0.001, RD=0.04 [range, 0.01 to 0.06]; I 2 =29%). Overall immediate bleeding: Statistical significance was found to favor Endocut, ( P =0.05; RD=-0.15 [range, -0.29 to -0.00]; I 2 =93%). No statistical significance between current modes was found in immediate bleeding without endoscopic intervention ( P =0.10; RD=-0.13 [range, -0.29 to 0.02]; I 2 =88%), immediate bleeding with endoscopic intervention ( P =0.06; RD=-0.07 [range, -0.14 to 0.00]; I 2 =76%), delayed bleeding (P=0.40; RD=0.01 [range, -0.02 to 0.05]; I 2 =72%), zipper cut ( P =0.58; RD=-0.03 [range, -0.16 to 0.09]; I 2 =97%), perforation ( P =1.00; RD=0.00 [range, -0.01 to 0.01]; I 2 =0%) and cholangitis ( P =0.77; RD=0.00 [range, -0.01 to 0.02]; I 2 =29%). Conclusions The available data in the literature show that Endocut carries an increased risk for PEP and does not prevent delayed or clinically significant bleeding, although it prevents intraprocedural bleeding. Based on such findings, Pure cut should be the preferred electric current mode for biliary sphincterotomy.
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Affiliation(s)
- Luiza Bicudo de Oliveira
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
| | - Mateus Pereira Funari
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
| | - Angelo So Taa Kum
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
| | - Alexandre de Moraes Bestetti
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
| | - Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
- Gastroenterology and Hepatology Division, Mayo Clinic, Rochester, United States
| | - Tomazo Antonio Prince Franzini
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
| | - Eduardo Turiani Hourneaux Moura
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
| | - Luiza Martins Baroni
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
| | - Matheus Ferreira de Carvalho
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Division of Gastroenterology, Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo – HC/FMUSP, Sao Paulo, Brazil
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Pereira Funari M, Ottoboni Brunaldi V, Mendonça Proença I, Aniz Gomes PV, Almeida Queiroz LT, Zamban Vieira Y, Eiji Matuguma S, Ide E, Prince Franzini TA, Lera Dos Santos ME, Cheng S, Kazuyoshi Minata M, Dos Santos JS, Turiani Hourneaux de Moura D, Kemp R, Guimarães Hourneaux de Moura E. Pure Cut or Endocut for Biliary Sphincterotomy? A Multicenter Randomized Clinical Trial. Am J Gastroenterol 2023; 118:1871-1879. [PMID: 37543748 DOI: 10.14309/ajg.0000000000002458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/13/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Adverse events (AE) after endoscopic retrograde cholangiopancreatography (ERCP) are not uncommon and post-ERCP acute pancreatitis (PEP) is the most important one. Thermal injury from biliary sphincterotomy may play an important role and trigger PEP or bleeding. Therefore, this study evaluated the outcomes of 2 electric current modes used during biliary sphincterotomy. METHODS From October 2019 to August 2021, consecutive patients with native papilla undergoing ERCP with biliary sphincterotomy were randomized to either the pure cut or endocut after cannulation. The primary outcome was PEP incidence. Secondary outcomes included intraprocedural and delayed bleeding, infection, and perforation. RESULTS A total of 550 patients were randomized (272 pure cut and 278 endocut). The overall PEP rate was 4.0% and significantly higher in the endocut group (5.8% vs 2.2%, P = 0.034). Univariate analysis revealed >5 attempts ( P = 0.004) and endocut mode ( P = 0.034) as risk factors for PEP. Multivariate analysis revealed >5 attempts ( P = 0.005) and a trend for endocut mode as risk factors for PEP ( P = 0.052). Intraprocedural bleeding occurred more often with pure cut ( P = 0.018), but all cases were controlled endoscopically during the ERCP. Delayed bleeding was more frequent with endocut ( P = 0.047). There was no difference in perforation ( P = 1.0) or infection ( P = 0.4999) between the groups. DISCUSSION Endocut mode may increase thermal injury leading to higher rates of PEP and delayed bleeding, whereas pure cut is associated with increased intraprocedural bleeding without clinical repercussion. The electric current mode is not related to perforation or infection. Further RCT assessing the impact of electric current on AE with overlapping preventive measures such as rectal nonsteroidal anti-inflammatory drugs and hyperhydration are needed. The study was submitted to the Brazilian Clinical Trials Platform ( http://www.ensaiosclinicos.gov.br ) under the registry number RBR-5d27tn.
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Affiliation(s)
- Mateus Pereira Funari
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Vitor Ottoboni Brunaldi
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Igor Mendonça Proença
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Pedro Victor Aniz Gomes
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Tobias Almeida Queiroz
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Yuri Zamban Vieira
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Sergio Eiji Matuguma
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Edson Ide
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | - Spencer Cheng
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Maurício Kazuyoshi Minata
- Gastrointestinal Endoscopy Unit, Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil
| | - José Sebastião Dos Santos
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
| | | | - Rafael Kemp
- Surgery and Anatomy Department, Division of Gastrointestinal Surgery, Faculty of Medicine of Ribeirão Preto, Ribeirão Preto, Brazil
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Jena A, Jain S, Sundaram S, Singh AK, Chandnani S, Rathi P. Electrosurgical unit in GI endoscopy: the proper settings for practice. Expert Rev Gastroenterol Hepatol 2023; 17:825-835. [PMID: 37497836 DOI: 10.1080/17474124.2023.2242243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/14/2023] [Accepted: 07/26/2023] [Indexed: 07/28/2023]
Abstract
INTRODUCTION Electrosurgical unit (ESU) is integral to the endoscopy unit. The proper knowledge of the Mode with setting is essential for good therapeutic outcomes and the safety of the patients. AREAS COVERED ESU generates high-frequency electric current, which could perform cutting and coagulation for various therapeutic interventions. We review the proper settings for common endoscopic interventions like hemostasis, polypectomy, sphincterotomy, and advanced procedures like endoscopic ultrasound-guided cysto-gastrostomy, bile duct drainage, and endoscopic Ampullectomy. We review the various waveforms of ESU in practice in endoscopy, including special conditions like patients with pacemakers. EXPERT OPINION Knowledge of the waveforms' duty cycle and crest factor is necessary. A high-duty cycle and lower crest factor lead to a good cutting effect on the tissue. Endocut is the most commonly used Mode in ESU in endoscopic practices like sphincterotomy and polypectomy. Endocut I mode (effect 1-2, duration 3, interval 3) is used for endoscopic sphincterotomy, while Forced Coag mode (Effect 2, 60 W) controls post-sphincterotomy bleeding. Endocut Q mode (Effect 2-3, duration 1, interval 3) is used for cutting the polyp, while Forced Coag mode (Effect 2, 60 W) is used before cutting for pre-coagulation of the stalk.
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Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Shubham Jain
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Sridhar Sundaram
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Hospital, Mumbai, India
| | - Anupam Kumar Singh
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Chandnani
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
| | - Pravin Rathi
- Department of Gastroenterology, BYL Nair Hospital and Topiwala National Medical College, Mumbai, India
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Dang DT, Suresh S, Vance RB, Singla S, Javia S, Watson A, Chathadi KV, Katukuri V, Pompa R, Stidham RW, Zuchelli T, Piraka C. Outcomes of cold snare piecemeal EMR for nonampullary small-bowel adenomas larger than 1 cm: a retrospective study. Gastrointest Endosc 2022; 95:1176-1182. [PMID: 34971667 DOI: 10.1016/j.gie.2021.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/17/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Nonampullary small-bowel adenomas ≥10 mm are typically resected using cautery-based polypectomy, which is associated with significant adverse events. Studies have demonstrated the safety and efficacy of piecemeal cold snare EMR for removing large colon polyps. Our aim was to assess the safety and efficacy of cold snare EMR for removal of large adenomas in the small bowel. METHODS A retrospective study of patients who underwent lift and piecemeal cold snare EMR of small-bowel adenomas ≥1 cm between January 2014 and March 2019 was conducted at a tertiary care medical center. Polyp characteristics at the time of index and surveillance endoscopy were collected. Primary outcomes were residual or recurrent adenoma (RRA) seen on surveillance endoscopy, polyp eradication rate, and number of endoscopic procedures required for eradication. Adverse events including immediate and delayed bleeding, perforation, stricture, pancreatitis, and postpolypectomy syndrome were assessed. RESULTS Of 43 patients who underwent piecemeal cold snare EMR, 39 had follow-up endoscopy. Polyps ranged in size from 10 to 70 mm (mean, 26.5 mm). RRA was found in 18 patients (46%), with increased polyp size correlating with higher recurrence (P < .001). Polyp eradication was observed in 35 patients (89%), requiring a median of 2 (range, 1-6) endoscopic procedures. Only 1 patient (2.3%) had immediate postprocedural bleeding. No cases of perforation or postpolypectomy syndrome were seen. CONCLUSIONS Piecemeal cold snare EMR may be a feasible, safe, and efficacious technique for small-bowel polyps >10 mm. Prospective, randomized studies are needed to assess how outcomes compare with traditional cautery-based polypectomy.
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Affiliation(s)
- Duyen T Dang
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Suraj Suresh
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - R Brooks Vance
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sumit Singla
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Siddharth Javia
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Andrew Watson
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Vinay Katukuri
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Robert Pompa
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ryan W Stidham
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan
| | - Tobias Zuchelli
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Cyrus Piraka
- Division of Gastroenterology, Henry Ford Hospital, Detroit, Michigan, USA
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Bai Y, Yang F, Liu C, Li DF, Wang S, Lin R, Ding Z, Meng WB, Li ZS, Linghu EQ. Expert consensus on the clinical application of high-frequency electrosurgery in digestive endoscopy (2020, Shanghai). J Dig Dis 2022; 23:2-12. [PMID: 34953023 DOI: 10.1111/1751-2980.13074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 12/11/2022]
Abstract
High-frequency electrosurgery has been widely applied in digestive endoscopy with constantly expanding indications. However, high-frequency electrosurgery may cause possible complications such as hemorrhage or perforation during or after the procedure, of which endoscopists must be cautious. Digestive endoscopists must have a firm grasp of the principles of high-frequency electrosurgery as well as its safety issues so as to improve the safety of its clinical application. To this end, experts in gastroenterology and hepatology, digestive endoscopy, surgery, nursing and other related fields were invited to draft a consensus on the clinical application of high-frequency electrosurgery in digestive endoscopy based on relevant domestic and international literatures and their experiences.
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Affiliation(s)
- Yu Bai
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Fan Yang
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - Cui Liu
- Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - De Feng Li
- Department of Gastroenterology, Shenzhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong Province, China
| | - Shi Wang
- Endoscopy Center, Cancer Hospital of the University of Chinese Academy of Sciences, Hangzhou, Zhejiang Province, China
| | - Rong Lin
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhen Ding
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wen Bo Meng
- Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Zhao Shen Li
- Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China
| | - En Qiang Linghu
- Department of Gastroenterology and Hepatology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Veitch AM, Radaelli F, Alikhan R, Dumonceau JM, Eaton D, Jerrome J, Lester W, Nylander D, Thoufeeq M, Vanbiervliet G, Wilkinson JR, van Hooft JE. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Endoscopy 2021; 53:947-969. [PMID: 34359080 PMCID: PMC8390296 DOI: 10.1055/a-1547-2282] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles, and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.
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Affiliation(s)
- Andrew M. Veitch
- Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | | | - Raza Alikhan
- Department of Haematology Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Jean-Marc Dumonceau
- Department of Gastroenterology, Charleroi University Hospitals, Charleroi, Belgium
| | | | | | - Will Lester
- Department of Haematology University Hospitals Birmingham NHS Foundation Trust, Birmingham,
| | - David Nylander
- Department of Gastroenterology, The Newcastle-upon-Tyne NHS Foundation Trust, Newcastle-upon-Tyne
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | | | - James R. Wilkinson
- Department of Interventional Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Jeanin E. van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, Netherlands
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7
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Veitch AM, Radaelli F, Alikhan R, Dumonceau JM, Eaton D, Jerrome J, Lester W, Nylander D, Thoufeeq M, Vanbiervliet G, Wilkinson JR, Van Hooft JE. Endoscopy in patients on antiplatelet or anticoagulant therapy: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guideline update. Gut 2021; 70:1611-1628. [PMID: 34362780 PMCID: PMC8355884 DOI: 10.1136/gutjnl-2021-325184] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/20/2021] [Indexed: 12/17/2022]
Abstract
This is a collaboration between the British Society of Gastroenterology (BSG) and the European Society of Gastrointestinal Endoscopy (ESGE), and is a scheduled update of their 2016 guideline on endoscopy in patients on antiplatelet or anticoagulant therapy. The guideline development committee included representatives from the British Society of Haematology, the British Cardiovascular Intervention Society, and two patient representatives from the charities Anticoagulation UK and Thrombosis UK, as well as gastroenterologists. The process conformed to AGREE II principles and the quality of evidence and strength of recommendations were derived using GRADE methodology. Prior to submission for publication, consultation was made with all member societies of ESGE, including BSG. Evidence-based revisions have been made to the risk categories for endoscopic procedures, and to the categories for risks of thrombosis. In particular a more detailed risk analysis for atrial fibrillation has been employed, and the recommendations for direct oral anticoagulants have been strengthened in light of trial data published since the previous version. A section has been added on the management of patients presenting with acute GI haemorrhage. Important patient considerations are highlighted. Recommendations are based on the risk balance between thrombosis and haemorrhage in given situations.
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Affiliation(s)
- Andrew M Veitch
- Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | | | - Raza Alikhan
- Haematology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | | | | | - Will Lester
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - David Nylander
- Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Mo Thoufeeq
- Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - James R Wilkinson
- Interventional Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jeanin E Van Hooft
- Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
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Bhandari P, Longcroft-Wheaton G, Libanio D, Pimentel-Nunes P, Albeniz E, Pioche M, Sidhu R, Spada C, Anderloni A, Repici A, Haidry R, Barthet M, Neumann H, Antonelli G, Testoni A, Ponchon T, Siersema PD, Fuccio L, Hassan C, Dinis-Ribeiro M. Revising the European Society of Gastrointestinal Endoscopy (ESGE) research priorities: a research progress update. Endoscopy 2021; 53:535-554. [PMID: 33822332 DOI: 10.1055/a-1397-3005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND One of the aims of the European Society of Gastrointestinal Endoscopy (ESGE) is to encourage high quality endoscopic research at a European level. In 2016, the ESGE research committee published a set of research priorities. As endoscopic research is flourishing, we aimed to review the literature and determine whether endoscopic research over the last 4 years had managed to address any of our previously published priorities. METHODS As the previously published priorities were grouped under seven different domains, a working party with at least two European experts was created for each domain to review all the priorities under that domain. A structured review form was developed to standardize the review process. The group conducted an extensive literature search relevant to each of the priorities and then graded the priorities into three categories: (1) no longer a priority (well-designed trial, incorporated in national/international guidelines or adopted in routine clinical practice); (2) remains a priority (i. e. the above criterion was not met); (3) redefine the existing priority (i. e. the priority was too vague with the research question not clearly defined). RESULTS The previous ESGE research priorities document published in 2016 had 26 research priorities under seven domains. Our review of these priorities has resulted in seven priorities being removed from the list, one priority being partially removed, another seven being redefined to make them more precise, with eleven priorities remaining unchanged. This is a reflection of a rapid surge in endoscopic research, resulting in 27 % of research questions having already been answered and another 27 % requiring redefinition. CONCLUSIONS Our extensive review process has led to the removal of seven research priorities from the previous (2016) list, leaving 19 research priorities that have been redefined to make them more precise and relevant for researchers and funding bodies to target.
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Affiliation(s)
- Pradeep Bhandari
- Department of Gastroenterology, Portsmouth University Hospital NHS Trust, Portsmouth, UK
| | | | - Diogo Libanio
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Pedro Pimentel-Nunes
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
| | - Eduardo Albeniz
- Gastroenterology Department, Endoscopy Unit, Complejo Hospitalario de Navarra, Navarrabiomed-UPNA-IdiSNA, Pamplona, Spain
| | - Mathieu Pioche
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Reena Sidhu
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Cristiano Spada
- Digestive Endoscopy and Gastroenterology, Fondazione Poliambulanza, Brescia, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Digestive Endoscopy Unit, IRCSS Humanitas Research Hospital, Milan, Italy
| | - Rehan Haidry
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Marc Barthet
- Department of Gastroenterology, Hôpital Nord, Assistance publique des hôpitaux de Marseille, Marseille, France
| | - Helmut Neumann
- Department of Medicine I, University Medical Center Mainz, Mainz, Germany.,GastroZentrum Lippe, Bad Salzuflen, Germany
| | - Giulio Antonelli
- Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy.,Nuovo Regina Margherita Hospital, Rome, Italy.,Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Thierry Ponchon
- Gastroenterology Division, Edouard Herriot Hospital, Lyon, France
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lorenzo Fuccio
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Mario Dinis-Ribeiro
- Gastroenterology Department, Portuguese Oncology Institute of Porto, Porto, Portugal.,Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto, Portugal
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Severe complications of chronic cholelithiasis treatment. Am J Emerg Med 2021; 48:374.e5-374.e12. [PMID: 33773867 DOI: 10.1016/j.ajem.2021.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Gallstone disease is a burden affecting about 15% percent of the population around the world. The complications of gallstone disease are numerous and many require emergency care. Severe complications are not uncommon and require special attention, as lethal outcome is possible. CASE PRESENTATION We present a retrospective analysis of eight cases describing severe complications of gallstones in patients undergoing endoscopic treatment of chronic gallstones conditions. All patients were admitted to our emergency care department following symptoms onset. The diagnostic difficulties, treatment strategies and outcomes are presented. The associated risk factors and preventative measures are discussed. Two patients developed profuse bleeding, two developed acute pancreatitis, two patients had perforation related complications. One rare case of bilioma and one case of iatrogenic injury are presented. All patients had severe condition, in two cases lethal outcome was a result of co-morbidity and difficulties in management. CONCLUSION Special care should be taken in patients with risk factors of severe complications in order to improve outcome and prevent the development of life-threatening conditions.
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Hedjoudje A, Cheurfa C, Farha J, Jaïs B, Aubert A, Lorenzo D, Maire F, Badurdeen D, Kumbhari V, Prat F. Safety of different electrocautery modes for endoscopic sphincterotomy: a Bayesian network meta-analysis. Ther Adv Gastrointest Endosc 2021; 14:26317745211062983. [PMID: 34993472 PMCID: PMC8725216 DOI: 10.1177/26317745211062983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 11/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background and aims: Post-endoscopic retrograde cholangiopancreatography acute pancreatitis (PAP)
and post-sphincterotomy hemorrhage are known adverse events of
post-endoscopic retrograde cholangiopancreatography. Various electrosurgical
currents can be used for endoscopic sphincterotomy. The extent to which this
influences adverse events remains unclear. We assessed the comparative
safety of different electrosurgical currents, through a Bayesian network
meta-analysis of published studies merging direct and indirect comparison of
trials. Methods: We performed a Bayesian random-effects network meta-analysis of randomized
controlled trials that compared the safety of different electrocautery modes
for endoscopic sphincterotomy. Results: Nine studies comparing four electrocautery modes (blended cut, pure cut,
endocut, and pure cut followed by blended cut) with a combined enrollment of
1615 patients were included. The pooled results of the network meta-analysis
did not show a significant difference in preventing post-sphincterotomy
pancreatitis when comparing electrocautery modes. However, pure cut was
associated with a statistically significant increased risk of bleeding
compared with endocut [relative risk = 4.30; 95% confidence interval
(1.53–12.87)]. On the other hand, the pooled results of the network
meta-analysis showed no significant difference in prevention of bleeding
when comparing blended cut versus endocut, pure cut
followed by blended cut versus endocut, pure cut followed
by blended cut versus blended cut, pure cut
versus blended cut, and pure cut
versus pure cut followed by blended cut. The results of
rank probability found that endocut was most likely to be ranked the
best. Conclusion: No electrocautery mode was superior to another with regard to preventing PAP.
Endocut was superior with respect to preventing bleeding. Therefore, we
suggest performing endoscopic sphincterotomy with endocut.
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Affiliation(s)
- Abdellah Hedjoudje
- Service d'endoscopie digestive, DMU Digestif, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, 100 boulevard du Général Leclerc, 92110 Clichy, France. Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Chérifa Cheurfa
- Université de Paris, Epidemiology and Statistics, Sorbonne Paris Cité Research Center, (CRESS-UMR1153), INSERM, Cochrane France, Paris, France
| | - Jad Farha
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Bénédicte Jaïs
- Service d'endoscopie digestive, DMU Digestif, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Alain Aubert
- Service d'endoscopie digestive, DMU Digestif, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Diane Lorenzo
- Service d'endoscopie digestive, DMU Digestif, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Frédérique Maire
- Service d'endoscopie digestive, DMU Digestif, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
| | - Dilhana Badurdeen
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Vivek Kumbhari
- Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Frédéric Prat
- Service d'endoscopie digestive, DMU Digestif, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Clichy, France
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Funari MP, Ribeiro IB, de Moura DTH, Bernardo WM, Brunaldi VO, Rezende DT, Resende RH, de Marco MO, Franzini TAP, de Moura EGH. Adverse events after biliary sphincterotomy: Does the electric current mode make a difference? A systematic review and meta-analysis of randomized controlled trials. Clin Res Hepatol Gastroenterol 2020; 44:739-752. [PMID: 32088149 DOI: 10.1016/j.clinre.2019.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/24/2019] [Accepted: 12/18/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Biliary sphincterotomy is an invasive method that allows access to the bile ducts, however, this procedure is not exempt of complications. Studies in the literature indicate that the mode of electric current used for sphincterotomy may carry different incidences of adverse events such as pancreatitis, hemorrhage, perforation, and cholangitis. AIM To evaluate the safety of different modes of electrical current during biliary sphincterotomy based on incidence of adverse events. METHODS We searched articles for this systematic review in Medline, EMBASE, Central Cochrane, Lilacs, and gray literature from inception to September 2019. Data from studies describing different types of electric current were meta-analyzed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The following electric current modalities were evaluated: endocut, blend, pure cut, pure cut followed by blend, monopolar, and bipolar. RESULTS A total of 1791 patients from 11 randomized clinical trials evaluating the following comparisons: 1. Endocut vs Blend: No statistical difference in the incidence of bleeding (7% vs 13.4%; RD: -0.11 [-0.31, 0.08], P=0.27, I2=86%), pancreatitis (4.4% vs 3.5%; RD: 0.01 [-0.03, 0.04], P=0.62, I2=48%) and perforation (absence of cases in both arms). 2. Endocut vs Pure cut: Higher incidence of mild bleeding (without drop in hemoglobin levels, clinical repercussion or need for endoscopic intervention) in the pure cut group (9.2% vs 28.8%; RD: -0.19 [-0.27, -0.12], P<0.00001, I2=0%). No statistical difference regarding pancreatitis (5.2% vs 0.9%; RD: 0.05 [-0.01, 0.11], P=0.12, I2=57%), perforation (0.4% vs 0%; RD: 0.00 [-0.01, 0.02], P=0.7, I2=0%) or cholangitis (1.8% vs 3.2%; RD: -0.01 [-0.09, 0.06], P=0,7). 3. Pure cut vs blend: higher incidence of mild bleeding in the pure cut group (40.4% vs 16.7%; RD: 0.24 [0.15, 0.33], P<0.00001, I2=0%). No statistical difference concerning incidence of pancreatitis or cholangitis. 4. Pure cut vs Pure cut followed by Blend: No statistical difference regarding incidence of bleeding (22.5% vs 11.7%; RD: -0.10 [-0.24, 0.04], P=0.18, I2=61%) and pancreatitis (8.9% vs 14.8%; RD 0.06 [-0.02, 0.13], P=0.12, I2=0%). 5. Blend vs pure cut followed by blend: no statistical difference regarding incidence of bleeding and pancreatitis (11.3% vs 10.4%; RD -0.01 [-0.11, 0.09], P=0.82, I2=0%). 6. Monopolar vs bipolar: higher incidence of pancreatitis in the monopolar mode group (12% vs 0%; RD 0.12 [0.02, 0.22], P=0.01). CONCLUSION Pure cut carries higher incidences of mild bleeding compared to endocut and blend. However, this modality might present a lower incidence of pancreatitis. The monopolar mode elicits higher rates of pancreatitis in comparison with the bipolar mode. There is no difference in incidence of cholangitis or perforation between different types of electric current. There is a lack of evidence in the literature to recommend one method over the others, therefore new studies are warranted. As there is no perfect electric current mode, the choice in clinical practice must be based on the patient risk factors.
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Affiliation(s)
- Mateus Pereira Funari
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Igor Braga Ribeiro
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil.
| | - Diogo Turiani Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil; Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Vitor Ottoboni Brunaldi
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Daniel Tavares Rezende
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Ricardo Hannum Resende
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Michele Oliveira de Marco
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Tomazo Antonio Prince Franzini
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - HC/FMUSP, Instituto Central, Prédio dos Ambulatórios, Av. Dr. Enéas de Carvalho Aguiar 255, Pinheiros, São Paulo, Brazil
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