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Cobb W, Harris S, Xavier J, de la Fuente SG. Systematic review of long-term effectiveness of endoscopic gastrojejunostomy in patients presenting with gastric outlet obstruction from periampullary malignancies. Surg Endosc 2024:10.1007/s00464-024-10943-3. [PMID: 38886233 DOI: 10.1007/s00464-024-10943-3] [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: 02/07/2024] [Accepted: 05/19/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Recently, endoscopic ultrasound-guided (EUS) gastrojejunostomy (GJ) has emerged as an alternative option to surgical palliation and endoscopic duodenal stenting for malignant gastric outlet obstruction (GOO). Although early success rates are commonly reported with the technique, there is a paucity of data regarding the long-term efficacy of this approach. In this study, we investigated long-term outcomes in patients that underwent EUS-guided GJ for palliation of periampullary malignancies. METHODS From a total of 192 studies that were reviewed, 6 studies with a follow-up time frame of a minimum of 5 months were analyzed, totaling 238 patients. Outcome variables included technical success rate, clinical success rate, adverse events, symptom recurrence, and re-intervention rates. RESULTS The cohort of 238 patients had a technical success rate of 93.7% and a clinical success rate of 92.9%. A total of 25 patients (10.5%) experienced adverse events associated with EUS-GJ. A total of 14 patients (5.9%) experienced recurrence of GOO symptoms within 5 months. A total of 14 patients (5.9%) underwent re-intervention with the first 5 months. CONCLUSIONS This systematic review shows that data are scarce regarding long-term effectiveness of EUS-guided GJ. Even though early success rates have been reported, further studies are needed to focus on long-term efficacy of this approach. Until such studies become available, surgical palliation should continue to be the treatment of choice for patients with malignant GOO with a prolonged life expectancy.
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Affiliation(s)
- William Cobb
- Department of Surgery, AdventHealth Orlando, Orlando, FL, USA
| | - Shelby Harris
- Department of Surgery, AdventHealth Orlando, Orlando, FL, USA
| | - Jonathan Xavier
- School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Sebastian G de la Fuente
- Department of Surgery, AdventHealth Orlando, Orlando, FL, USA.
- School of Medicine, Loma Linda University, Loma Linda, CA, USA.
- Department of Surgical Oncology, 2415 N. Orange Ave, Suite 400, Orlando, FL, 32804, USA.
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Asghar M, Forcione D, Puli SR. Endoscopic ultrasound-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: a systematic review and meta-analysis. Therap Adv Gastroenterol 2024; 17:17562848241248219. [PMID: 38855340 PMCID: PMC11159541 DOI: 10.1177/17562848241248219] [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: 11/12/2023] [Accepted: 04/02/2024] [Indexed: 06/11/2024] Open
Abstract
Background The symptoms of gastric outlet obstruction have traditionally been managed surgically or endoscopically. Enteral stenting (ES) is a less invasive endoscopic treatment strategy for this condition. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently become a potential alternative technique. Objectives We conducted a systematic review and meta-analysis of the effectiveness and safety profile of EUS-GE compared with ES. Design Meta-analysis and systematic review. Data sources and methods We searched multiple databases from inception to August 2023 to identify studies that reported the effectiveness and safety of EUS-GE compared with ES. The outcomes of technical success, clinical success, and adverse events (AEs) were evaluated. Pooled proportions were calculated using both fixed and random effects models. Results We included 13 studies with 1762 patients in our final analysis. The pooled rates of technical success for EUS-GE were 95.59% [95% confidence interval (CI), 94.01-97.44, I 2 = 32] and 97.96% (95% CI, 96.06-99.25, I 2 = 63) for ES. The pooled rate of clinical success for EUS-GE was 93.62% (95% CI, 90.76-95.98, I 2 = 54) while for ES it was lower at 85.57% (95% CI, 79.63-90.63, I 2 = 81). The pooled odds ratio (OR) of clinical success was higher for EUS-GE compared to ES at 2.71 (95% CI, 1.87-3.93). The pooled OR of clinical success for EUS-GE was higher compared to ES at 2.72 (95% CI, 1.86-3.97, I 2 = 0). The pooled rates of re-intervention for EUS-GE were lower at 3.77% (95% CI, 1.77-6.46, I 2 = 44) compared with ES, which was 25.13% (95% CI, 18.96-31.85, I 2 = 69). The pooled OR of the rate of re-intervention in the ES group was higher at 7.96 (95% CI, 4.41-14.38, I 2 = 13). Overall, the pooled rate for AEs for EUS-GE was 8.97% (95% CI, 6.88-11.30, I 2 = 15), whereas that for ES was 19.63% (95% CI, 11.75-28.94, I 2 = 89). Conclusion EUS-GE and ES are comparable in terms of their technical effectiveness. However, EUS-GE has demonstrated improved clinical effectiveness, a lower need for re-intervention, and a better safety profile compared to ES for palliation of gastric outlet obstruction.
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Affiliation(s)
- Muhammad Asghar
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, 530 NE Glen Oak Avenue, Peoria, IL 61637, USA
| | | | - Srinivas Reddy Puli
- Department of Gastroenterology and Hepatology, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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Rosario-Morel MM, Soto-Solis R, Picazo-Ferrera K, Torres-Ruiz MI, Estradas-Trujillo JA, Gallardo-Ramírez MA, Darwich-del Moral GA, Waller-González LA. Endoscopic ultrasound-guided gastroenterostomy for gastric outlet obstruction in Mexico. World J Surg Proced 2024; 14:15-20. [DOI: 10.5412/wjsp.v14.i3.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/17/2024] [Accepted: 04/16/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emer-ged as an alternative treatment for gastric outlet obstruction (GOO) in selected patients.
AIM To report the initial experience of EUS-GE in patients with GOO.
METHODS This study was a retrospective, observational, multicenter study in which the data from 10 patients who underwent EUS-GE due to GOO between September 2021 and May 2023 were collected. We analyzed technical success, clinical success, adverse events, and survival. Technical success was defined as adequate position-ing and deployment of the stent. Clinical success was defined as the patient’s ability to tolerate oral intake without vomiting 7 d after the procedure. Post-procedural adverse events were recorded.
RESULTS Eleven procedures in 10 patients with GOO were included. The mean age of the patients was 67.5 years (range: 56-77 years). Malignant GOO was present in 9 patients. Technical success was achieved in 9/11 procedures (82%). Among them, clinical success was achieved in 9 patients (100%). Adverse events occurred in 1 patient (9%). The median survival was 3 months (n = 7; range: 1-8 months).
CONCLUSION EUS-GE is a feasible therapeutic option in the treatment of GOO.
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Affiliation(s)
| | - Rodrigo Soto-Solis
- Department of Endoscopy, Centro Médico Nacional “20 de Noviembre,” ISSSTE, Mexico City 03229, Mexico
- Department of Gastroenterology, Hospital Ángeles Pedregal, Mexico City 10700, Mexico
| | | | - Miriam Idalia Torres-Ruiz
- Department of Endoscopy, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico
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Conti Bellocchi MC, Gasparini E, Stigliano S, Ramai D, Bernardoni L, Di Matteo FM, Facciorusso A, Frulloni L, Crinò SF. Endoscopic Ultrasound-Guided Gastroenterostomy versus Enteral Stenting for Malignant Gastric Outlet Obstruction: A Retrospective Propensity Score-Matched Study. Cancers (Basel) 2024; 16:724. [PMID: 38398115 PMCID: PMC10887005 DOI: 10.3390/cancers16040724] [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: 01/09/2024] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen apposing metal stent has emerged as a minimally invasive treatment for the management of malignant gastric outlet obstruction (mGOO). We aimed to compare EUS-GE with enteral stenting (ES) for the treatment of mGOO. METHODS Patients who underwent EUS-GE or ES for mGOO between June 2017 and June 2023 at two Italian centers were retrospectively identified. The primary outcome was stent dysfunction. Secondary outcomes included technical success, clinical failure, safety, and hospital length of stay. A propensity score-matching analysis was performed using multiple covariates. RESULTS Overall, 198 patients were included (66 EUS-GE and 132 ES). The stent dysfunction rate was 3.1% and 16.9% following EUS-GE and ES, respectively (p = 0.004). Using propensity score-matching, 45 patients were allocated to each group. The technical success rate was 100% for both groups. Stent dysfunction was higher in the ES group compared with the EUS-GE group (20% versus 4.4%, respectively; p = 0.022) without differences in clinical efficacy (p = 0.266) and safety (p = 0.085). A significantly shorter hospital stay was associated with EUS-GE compared with ES (7.5 ± 4.9 days vs. 12.5 ± 13.0 days, respectively; p = 0.018). Kaplan-Meier analyses confirmed a higher stent dysfunction-free survival rate after EUS-GE compared with ES (log-rank test; p = 0.05). CONCLUSION EUS-GE offers lower rates of stent dysfunction, longer stent patency, and shorter hospital stay compared with ES.
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Affiliation(s)
- Maria Cristina Conti Bellocchi
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
| | - Enrico Gasparini
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
| | - Serena Stigliano
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, 00128 Rome, Italy; (S.S.); (F.M.D.M.)
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Hospital, Salt Lake City, UT 84112, USA;
| | - Laura Bernardoni
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
| | - Francesco Maria Di Matteo
- Unit of Gastroenterology and Digestive Endoscopy, Campus Bio Medico University, 00128 Rome, Italy; (S.S.); (F.M.D.M.)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 00161 Foggia, Italy;
| | - Luca Frulloni
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
| | - Stefano Francesco Crinò
- Diagnostic and Interventional Endoscopy of Pancreas, The Pancreas Institute, G.B. Rossi University Hospital, 37134 Verona, Italy; (E.G.); (L.B.); (L.F.); (S.F.C.)
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Han S, Papachristou GI. Therapeutic Endoscopic Ultrasound for Complications of Pancreatic Cancer. Cancers (Basel) 2023; 16:29. [PMID: 38201458 PMCID: PMC10778123 DOI: 10.3390/cancers16010029] [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: 11/29/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Progression of pancreatic adenocarcinoma can result in disease complications such as biliary obstruction and gastric outlet obstruction. The recent advances in endoscopic ultrasound (EUS) have transformed EUS from a purely diagnostic technology to a therapeutic modality, particularly with the development of lumen-apposing metal stents. In terms of biliary drainage, EUS-guided choledochoduodenostomy and EUS-guided hepaticogastrostomy offer safe and effective techniques when conventional transpapillary stent placement via ERCP fails or is not possible. If these modalities are not feasible, EUS-guided gallbladder drainage offers yet another salvage technique when the cystic duct is non-involved by the cancer. Lastly, EUS-guided gastroenterostomy allows for an effective bypass treatment for cases of gastric outlet obstruction that enables patients to resume eating within several days. Future randomized studies comparing these techniques to current standard-of-care options are warranted to firmly establish therapeutic EUS procedures within the treatment algorithm for this challenging disease.
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Affiliation(s)
| | - Georgios I. Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
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Mulki R, Qayed E, Yang D, Chua TY, Singh A, Yu JX, Bartel MJ, Tadros MS, Villa EC, Lightdale JR. The 2022 top 10 list of endoscopy topics in medical publishing: an annual review by the American Society for Gastrointestinal Endoscopy Editorial Board. Gastrointest Endosc 2023; 98:1009-1016. [PMID: 37977661 DOI: 10.1016/j.gie.2023.08.021] [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: 07/24/2023] [Revised: 08/09/2023] [Accepted: 08/29/2023] [Indexed: 11/19/2023]
Abstract
Using a systematic literature search of original articles published during 2022 in Gastrointestinal Endoscopy and other high-impact medical and gastroenterology journals, the 10-member Editorial Board of the American Society for Gastrointestinal Endoscopy composed a list of the 10 most significant topic areas in GI endoscopy during the study year. Each Editorial Board member was directed to consider 3 criteria in generating candidate lists-significance, novelty, and global impact on clinical practice-and subject matter consensus was facilitated by the Chair through electronic voting. The 10 identified areas collectively represent advances in the following endoscopic spheres: artificial intelligence, endoscopic submucosal dissection, Barrett's esophagus, interventional EUS, endoscopic resection techniques, pancreaticobiliary endoscopy, management of acute pancreatitis, endoscopic environmental sustainability, the NordICC trial, and spiral enteroscopy. Each board member was assigned a consensus topic area around which to summarize relevant important articles, thereby generating this précis of the "top 10" endoscopic advances of 2022.
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Affiliation(s)
- Ramzi Mulki
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emad Qayed
- Division of Digestive Diseases, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Dennis Yang
- Center of Interventional Endoscopy (CIE) Advent Health, Orlando, Florida, USA
| | - Tiffany Y Chua
- Division of Digestive Diseases, Harbor-University of California Los Angeles, Torrance, California, USA
| | - Ajaypal Singh
- Division of Digestive Diseases and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Jessica X Yu
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Edward C Villa
- NorthShore University Health System, Chicago, Illinois, USA
| | - Jenifer R Lightdale
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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Li JS, Lin K, Tang J, Liu F, Fang J. EUS-guided gastroenterostomy for gastric outlet obstruction: a comprehensive meta-analysis. MINIM INVASIV THER 2023; 32:285-299. [PMID: 37310282 DOI: 10.1080/13645706.2023.2221336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE A comprehensive meta-analysis was performed to evaluate the efficacy and safety of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for benign and malignant gastric outlet obstruction (GOO). MATERIAL AND METHODS PubMed, Embase, Web of Science and Cochrane Library were searched to identify relevant studies. The primary outcomes evaluated technical success, clinical success, and adverse events (AEs). RESULTS Twenty‑six studies with 1493 patients were included in this meta-analysis. The pooled rates of technical success, clinical success, and overall AEs of EUS-GE were 94.0%, 89.9%, and 13.1%, respectively. Eight studies were included in the subgroup meta-analysis for comparative evaluation of EUS-GE and surgical gastroenterostomy (SGE), while seven studies were for EUS-GE and enteral stenting (ES). Compared with SGE, the pooled odds ratios (ORs) of technical success, clinical success, and overall AEs of EUS-GE were 0.17 (p = .003), 1.42 (p = .40), and 0.15 (p < .00001), respectively. When compared with ES, the above corresponding pooled ORs were 0.55 (p = .11), 2.64 (p < .0001), and 0.41 (p = .01), respectively. CONCLUSION Although it is technically challenging, this largest meta-analysis indicates that EUS‑GE has comparable and high technical and clinical success rates and hence a very effective minimally invasive procedure for GOO.
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Affiliation(s)
- Jia-Su Li
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Kun Lin
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jian Tang
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feng Liu
- Digestive Endoscopy Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Fang
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Magahis PT, Salgado S, Westerveld D, Dawod E, Carr-Locke DL, Sampath K, Sharaiha RZ, Mahadev S. Preferred techniques for endoscopic ultrasound-guided gastroenterostomy: a survey of expert endosonographers. Endosc Int Open 2023; 11:E1035-E1045. [PMID: 37954107 PMCID: PMC10635781 DOI: 10.1055/a-2185-6426] [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: 08/02/2023] [Accepted: 09/15/2023] [Indexed: 11/14/2023] Open
Abstract
Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is an emerging procedure that lacks technical standardization with limited adoption beyond expert centers. We surveyed high-volume endosonographers about the technical aspects of EUS-GE to describe how the procedure is currently performed at expert centers and identify targets for standardization. Methods Invitations to complete an electronic survey were distributed to 21 expert EUS practitioners at 19 U.S. centers. Respondents were surveyed about technical aspects of EUS-GE, indications, efficacy, safety, and attitudes toward the procedure. Results All 21 (100%) invited expert endoscopists completed the survey. Nine (42.9%) reported performing >10 EUS-GEs in the last 12 months. About half (47.6%, 10/21) puncture the target loop prior to lumen-apposing metal stent (LAMS) introduction, most often to confirm the loop is jejunum. No respondents reported guidewire placement prior to LAMS introduction. Most (71.4%, 15/21) do not use a guidewire at any time, while 28.6% (6/21) reported wire placement after distal flange deployment to secure the tract during apposition. Eight (38.1%, 8/21) reported at least one major adverse event, most commonly intraperitoneal LAMS deployment (87.5%, 7/8). Factors most often reported as advantageous for EUS-GE over enteral stenting included lack of papilla interference (33.3%, 7/21) and decreased occlusion risk (23.8%, 5/21). Conclusions Significant variation in performance technique for EUS-GE exists among expert US endoscopists, which may hinder widespread adoption and contribute to inconsistencies in reported patient outcomes. The granularity provided by these survey results may identify areas to focus standardization efforts and guide future studies on developing an ideal EUS-GE protocol.
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Affiliation(s)
| | - Sanjay Salgado
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Donevan Westerveld
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Enad Dawod
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - David L. Carr-Locke
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Kartik Sampath
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
| | - Reem Z. Sharaiha
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, United States
| | - Srihari Mahadev
- Division of Gastroenterology and Hepatology, NewYork-Presbyterian Weill Cornell Medical Center, New York, United States
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On W, Ahmed W, Everett S, Huggett M, Paranandi B. Utility of interventional endoscopic ultrasound in pancreatic cancer. Front Oncol 2023; 13:1252824. [PMID: 37781196 PMCID: PMC10540845 DOI: 10.3389/fonc.2023.1252824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Endoscopic ultrasound (EUS) has an important role in the management algorithm of patients with pancreatic ductal adenocarcinoma (PDAC), typically for its diagnostic utilities. The past two decades have seen a rapid expansion of the therapeutic capabilities of EUS. Interventional EUS is now one of the more exciting developments within the field of endoscopy. The local effects of PDAC tend to be in anatomical areas which are difficult to target and endoscopy has cemented itself as a key role in managing the clinical sequelae of PDAC. Interventional EUS is increasingly utilized in situations whereby conventional endoscopy is either impossible to perform or unsuccessful. It also adds a different dimension to the host of oncological and surgical treatments for patients with PDAC. In this review, we aim to summarize the various ways in which interventional EUS could benefit patients with PDAC and aim to provide a balanced commentary on the current evidence of interventional EUS in the literature.
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Affiliation(s)
- Wei On
- Department of Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Han S, Groce JR, Jalil S, Krishna SG, Lara LM, Lee PJ, Shah H, Papachristou GI. Dilation balloon-occlusion technique for EUS-guided gastrojejunostomy. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2023; 8:313-315. [PMID: 37575139 PMCID: PMC10422050 DOI: 10.1016/j.vgie.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Video 1Dilation balloon-occlusion technique for EUS-guided gastrojejunostomy.
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Affiliation(s)
- Samuel Han
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - J Royce Groce
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sajid Jalil
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Somashekar G Krishna
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Luis M Lara
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Peter J Lee
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Hamza Shah
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, Ohio State University Wexner Medical Center, Columbus, Ohio
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Garcia-Alonso FJ, Chavarria C, Subtil JC, Aparicio JR, Busto Bea V, Martinez-Moreno B, Vila JJ, Martín-Álvarez V, Sanchez-Delgado L, de la Serna-Higuera C, Perez-Miranda M. Prospective multicenter assessment of the impact of EUS-guided gastroenterostomy on patient quality of life in unresectable malignant gastric outlet obstruction. Gastrointest Endosc 2023; 98:28-35. [PMID: 36801458 DOI: 10.1016/j.gie.2023.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/30/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND AND AIMS EUS-guided gastroenterostomy (EUS-GE) is increasingly used for malignant gastric outlet obstruction (GOO) in inoperable patients. However, the impact of EUS-GE on patient quality of life (QoL) has not been evaluated prospectively. METHODS Consecutive patients with unresectable malignant GOO who underwent EUS-GE between August 2019 and May 2021 at 4 Spanish centers were prospectively assessed using the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 at baseline and 1 month after the procedure. Centralized follow-up by telephone calls was undertaken. The Gastric Outlet Obstruction Scoring System (GOOSS) was used to assess oral intake, defining clinical success as a GOOSS ≥2. Differences between baseline and 30-day QoL scores were assessed using a linear mixed model. RESULTS Sixty-four patients were enrolled, 33 (51.6%) men, with a median age of 77.3 years (interquartile range, 65.5-86.5). The most common diagnoses were pancreatic (35.9%) and gastric (31.3%) adenocarcinoma. Thirty-seven patients (57.9%) presented a 2/3 baseline Eastern Cooperative Oncology Group performance status score. Oral intake was restarted within 48 hours in 61 patients (95.3%), and the median postprocedure hospital stay was 3.5 days (interquartile range, 2-5). The 30-day clinical success rate was 83.3%. A clinically significant increase of 21.6 points (95% confidence interval, 11.5-31.7) in the global health status scale was documented, with significant improvements in nausea and vomiting, pain, constipation, and appetite loss. CONCLUSIONS EUS-GE relieves GOO symptoms in patients with unresectable malignancy, allowing rapid oral intake and hospital discharge. It also provides a clinically relevant increase in QoL scores at 30 days from baseline. (Clinical trial registration number: NCT04660695.).
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Affiliation(s)
| | - Carlos Chavarria
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Jose Carlos Subtil
- Gastroenterology Department, Clínica Universitaria de Navarra, Navarra, Pamplona, Spain
| | - Jose Ramón Aparicio
- Endoscopy Unit, Hospital General Universitario Dr Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
| | - Victoria Busto Bea
- Gastroenterology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | - Belén Martinez-Moreno
- Endoscopy Unit, Hospital General Universitario Dr Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante, ISABIAL, Alicante, Spain
| | - Juan J Vila
- Gastroenterology Department, Hospital Universitario de Navarra, Pamplona, Spain
| | | | | | | | - Manuel Perez-Miranda
- Gastroenterology Department, Hospital Universitario Río Hortega, Valladolid, Spain
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Gamboa A, Obstein K, Yachimski P. Duodenal stents versus EUS-gastroenterostomy for malignant gastric outlet obstruction. Gastrointest Endosc 2023; 97:998. [PMID: 37076205 DOI: 10.1016/j.gie.2022.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 04/21/2023]
Affiliation(s)
- Anthony Gamboa
- Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith Obstein
- Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patrick Yachimski
- Division of Gastroenterology, Hepatology & Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Sánchez Aldehuelo R, Vázquez-Sequeiros E. Response. Gastrointest Endosc 2023; 97:998-999. [PMID: 37076204 DOI: 10.1016/j.gie.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Rubén Sánchez Aldehuelo
- Unidad de Endoscopia, Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, Fundación para la Investigación Biomédica del Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Enrique Vázquez-Sequeiros
- Unidad de Endoscopia, Servicio de Gastroenterología y Hepatología, Hospital Universitario Ramón y Cajal, Madrid, Fundación para la Investigación Biomédica del Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
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Hodo Y, Takatori H, Komura T, Asahina Y, Chiba T, Takabatake H, Hasatani K, Nishino R, Yano M, Takata Y, Suda T, Shugo H, Nakanishi H, Yamada K, Miwa K, Kaji K, Nishitani M, Miyazawa M, Yamashita T. Prognostic impact of clinical outcome after endoscopic gastroduodenal stent placement for malignant gastric outlet obstruction: a multicenter retrospective cohort study using a time-dependent analysis. Therap Adv Gastroenterol 2023; 16:17562848231156279. [PMID: 36895284 PMCID: PMC9989375 DOI: 10.1177/17562848231156279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/24/2023] [Indexed: 03/08/2023] Open
Abstract
Background Endoscopic gastroduodenal stent (GDS) placement is widely used as a safe and effective method to rapidly improve gastrointestinal symptoms of malignant gastric outlet obstruction (MGOO). While previous studies reported the utility of chemotherapy after GDS placement for prognosis improvement, they did not fully address the issue of immortal time bias. Objectives To examine the association between prognosis and clinical course following endoscopic GDS placement, using a time-dependent analysis. Design Multicenter retrospective cohort study. Methods This study included 216 MGOO patients who underwent GDS placement between April 2010 and August 2020. Data of patient baseline characteristics, including age, gender, cancer type, performance status (PS), GDS type and length, GDS placement location, gastric outlet obstruction scoring system (GOOSS) score, and history of chemotherapy before GDS were collected. The clinical course following GDS placement was evaluated by GOOSS score, stent dysfunction, cholangitis, and chemotherapy. A Cox proportional hazards model was used to identify prognostic factors after GDS placement. Stent dysfunction, post-stent cholangitis, and post-stent chemotherapy were analyzed as time-dependent covariates. Results Mean GOOSS scores before and after GDS were 0.7 and 2.4, respectively, with significant improvement after GDS placement (p < 0.001). The median survival time after GDS placement was 79 [95% confidence interval (CI): 68-103] days. In multivariate Cox proportional hazards model with time-dependent covariates, PS 0-1 [hazard ratio (HR): 0.55, 95% CI: 0.40-0.75; p < 0.001], ascites (HR: 1.45, 95% CI: 1.04-2.01; p = 0.028), metastasis (HR: 1.84, 95% CI: 1.31-2.58; p < 0.001), post-stent cholangitis (HR: 2.38, 95% CI: 1.37-4.15; p = 0.002), and post-stent chemotherapy (HR: 0.01, 95% CI: 0.002-0.10; p < 0.001) significantly affected prognosis after GDS placement. Conclusion Post-stent cholangitis and tolerability to receive chemotherapy after GDS placement influenced prognosis in MGOO patients.
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Affiliation(s)
- Yuji Hodo
- Department of Gastroenterology, Saiseikai Kanazawa Hospital, Kanazawa, Ishikawa, Japan
| | - Hajime Takatori
- Department of Endoscopy, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, Ishikawa 921-8641, Japan
| | - Takuya Komura
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Yoshiro Asahina
- Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Ishikawa, Japan
| | - Tomoyoshi Chiba
- Department of Gastroenterology, Public Central Hospital of Matto Ishikawa, Hakusan, Ishikawa, Japan
| | - Hisashi Takabatake
- Department of Gastroenterology, Kanazawa Red Cross Hospital, Kanazawa, Ishikawa, Japan
| | - Kenkei Hasatani
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui, Fukui, Japan
| | - Ryuhei Nishino
- Department of Gastroenterology, Hakui General Hospital, Hakui, Ishikawa, Japan
| | - Masaaki Yano
- Department of Gastroenterology, Toyama Prefectural Central Hospital, Toyama, Toyama, Japan
| | - Yoshiko Takata
- Department of Gastroenterology, Tonami General Hospital, Tonami, Toyama, Japan
| | - Tsuyoshi Suda
- Department of Gastroenterology, Kanazawa Municipal Hospital, Kanazawa, Ishikawa, Japan
| | - Haruhiko Shugo
- Department of Gastroenterology, Keiju Medical Center, Nanao, Ishikawa, Japan
| | - Hiroyoshi Nakanishi
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | - Kazutoshi Yamada
- Department of Gastroenterology, Toyama City Hospital, Toyama, Toyama, Japan
| | - Kazuhiro Miwa
- Department of Gastroenterology, Komatsu Municipal Hospital, Komatsu, Ishikawa, Japan
| | - Kiichiro Kaji
- Department of Gastroenterology, Komatsu Sophia Hospital, Komatsu, Ishikawa, Japan
| | - Masaki Nishitani
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Masaki Miyazawa
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Taro Yamashita
- Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
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Perez-Cuadrado-Robles E, Alric H, Aidibi A, Bronswijk M, Vanella G, Gallois C, Benosman H, Ragot E, Rives-Lange C, Rahmi G, Cellier C. EUS-Guided Gastroenterostomy in Malignant Gastric Outlet Obstruction: A Comparative Study between First- and Second-Line Approaches after Enteral Stent Placement. Cancers (Basel) 2022; 14:cancers14225516. [PMID: 36428609 PMCID: PMC9688477 DOI: 10.3390/cancers14225516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is increasingly used in the setting of malignant gastric outlet obstruction (GOO). However, little is known about the role of primary EUS-GE. The aim of the present study is to compare the outcomes of EUS-GE by using the freehand technique as a first- and second-line approach after enteral stenting (ES). METHODS This is an observational single-center study using a prospectively collected database. All consecutive patients who underwent an EUS-GE using the freehand technique due to malignant GOO were included. Patients with previous gastric surgery, a wire-guided EUS-GE technique, or those presenting without GOO were excluded. The primary outcome was the clinical success, defined as a solid oral intake at 1 week after the procedure (GOO Score, GOOSS ≥ 2). The secondary outcomes were technical success and adverse event (AE) rates. The impact on nutritional parameters was also assessed. RESULTS Forty-five patients underwent an EUS-GE for all indications. Finally, 28 patients (mean age: 63 ± 17.2 years, 57.1% male) with (n = 13, 46.4%) and without (n = 15, 53.6%) a previous ES were included. The technical success was achieved in 25 cases (89.3%), with no differences between the two groups (92.3% vs. 86.7%, p = 1). The median limb diameter and procedure time were 27 mm (range:15-48) and 37 min. Overall, clinical success was achieved in 22 cases (88%), with three failures due to AEs (n = 2) or peritoneal carcinomatosis (n = 1). The diet progression was quicker in patients with a previous ES (GOOSS at 48 h, 2 vs. 1, p = 0.023), but the GOOSS at 1 week (p = 0.299), albumin gain (p = 0.366), and BMI gain (0.257) were comparable in the two groups. The AE rate was 7.1%. CONCLUSIONS EUS-GE achieves a high technical and clinical success in patients with GOO regardless of the presence of a previous ES. Patients with previous ES may have a quicker progression of their diet, but the GOOSS and nutritional status in the long term at 1 week or 1 month are comparable. Primary EUS-GE might require fewer procedures and less discontinuation of chemotherapy to achieve a comparable result.
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Affiliation(s)
- Enrique Perez-Cuadrado-Robles
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France
- Faculty of Medicine, University of Paris-Cité, 75006 Paris, France
- Correspondence: ; Tel.: +33-1-56-09-20-00; Fax: +33-1-56-09-29-34
| | - Hadrien Alric
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France
- Faculty of Medicine, University of Paris-Cité, 75006 Paris, France
| | - Ali Aidibi
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France
| | - Michiel Bronswijk
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, University of Leuven, 3000 Leuven, Belgium
- Department of Gastroenterology and Hepatology, Imelda Hospital Bonheiden, 2820 Bonheiden, Belgium
| | - Giuseppe Vanella
- Pancreatobiliary Endoscopy and Endosonography Division, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Claire Gallois
- Faculty of Medicine, University of Paris-Cité, 75006 Paris, France
- Department of Oncology, Georges-Pompidou European Hospital, 75015 Paris, France
| | - Hedi Benosman
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France
| | - Emilia Ragot
- Department of Surgery, Georges-Pompidou European Hospital, 75015 Paris, France
| | - Claire Rives-Lange
- Faculty of Medicine, University of Paris-Cité, 75006 Paris, France
- Department of Nutrition, Georges-Pompidou European Hospital, 75015 Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France
- Faculty of Medicine, University of Paris-Cité, 75006 Paris, France
| | - Christophe Cellier
- Department of Gastroenterology, Georges-Pompidou European Hospital, 75015 Paris, France
- Faculty of Medicine, University of Paris-Cité, 75006 Paris, France
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Ribas PHBV, De Moura DTH, Proença IM, Do Monte Júnior ES, Yvamoto EY, Hemerly MC, De Oliveira VL, Ribeiro IB, Sánchez-Luna SA, Bernardo WM, De Moura EGH. Endoscopic Ultrasound-Guided Gastroenterostomy for the Palliation of Gastric Outlet Obstruction (GOO): A Systematic Review and Meta-analysis of the Different Techniques. Cureus 2022; 14:e31526. [PMID: 36540454 PMCID: PMC9754671 DOI: 10.7759/cureus.31526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Gastric outlet obstruction (GOO) is usually associated with a poor prognosis and a significant decrease in a patient's quality of life. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumen-apposing metal stents (LAMS) has emerged as a safe and effective palliation procedure for GOO in patients that are unfit for surgery. Without an exclusive gold-standard technique for EUS-GE, we aimed to compare the currently available ones in this systematic review and meta-analysis, the first on this subspecialty. METHODS A comprehensive search from multiple electronic databases was performed. The search had a particular emphasis on the techniques used in performing EUS-GE. We identified all the studies in which EUS-GE was performed as palliation for GOO from its inception to the current date. The outcomes analyzed were the following: technical and clinical success, total and severe adverse events (AEs), procedure duration, and length of hospital stay (LOHS). RESULTS Twenty studies involving 863 patients were the basis of this statistical analysis. Patients underwent the following techniques: direct gastroenterostomy (DGE) (n=718), balloon-assisted gastroenterostomy (BAGE) (n=27), and endoscopic ultrasound (EUS)-guided double-balloon-occluded gastrojejunostomy bypass (n=118). In comparison to balloon-assisted techniques, DGE had a lower rate of AEs, -0.121 (95% CI -0.191 to -0.051 p=0.001); and LOHS for the DGE group, -2.684 (95% CI -1.031 to -4.337 p=0.001). The other analyzed outcomes presented no statistically significant differences. On a sub-analysis, BAGE showed a lower rate of AEs than EUS-guided double-balloon-occluded gastrojejunostomy bypass, -0.196 (95% CI -0.061 to -0.331 p=0.004). CONCLUSIONS EUS-GE is a safe and effective procedure for palliating GOO. When correctly administered, any of the analyzed techniques may be used to palliate GOO with similar technical and clinical outcomes. DGE had significantly lower rates of AEs and LOHS, which can be inferred as a safer procedure. These results should be interpreted cautiously due to the limited few studies that are available and accessible. Therefore, further well-designed, randomized clinical studies on the topic are warranted to compare the different techniques from more sources.
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Affiliation(s)
| | - Diogo Turiani H De Moura
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Igor M Proença
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Epifânio S Do Monte Júnior
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Erika Y Yvamoto
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Matheus C Hemerly
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Victor L De Oliveira
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Igor B Ribeiro
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Sergio A Sánchez-Luna
- Gastroenterology, University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, USA
| | - Wanderley M Bernardo
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
| | - Eduardo Guimarães H De Moura
- Gastroenterology, Hospital das Clínicas HCFMUSP Faculdade de Medicina, Universidade de São Paulo, São Paulo, BRA
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