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Li Q, Qin T, Liu T, Chen L, Jiang B. Cholangioscope-assisted endoscopic retrograde appendicitis therapy for occult chronic appendicitis. Endoscopy 2024; 56:E646-E647. [PMID: 39074821 PMCID: PMC11286331 DOI: 10.1055/a-2335-6826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Affiliation(s)
- Qianlong Li
- Fourth Department, Digestive Disease Center, Suining Central Hospital, Suining, China
| | - Ting Qin
- Infectious Diseases Department, Suining Central Hospital, Suining, China
| | - Tianyu Liu
- Fourth Department, Digestive Disease Center, Suining Central Hospital, Suining, China
| | - Linlin Chen
- Fourth Department, Digestive Disease Center, Suining Central Hospital, Suining, China
| | - Biao Jiang
- Fourth Department, Digestive Disease Center, Suining Central Hospital, Suining, China
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2
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Ren J, Huang S, Cai J, Li B, Yang G, Liao S, Zhang R. Endoscopic direct therapy for appendicitis and diverticulitis in one patient with right-sided abdominal pain. Endoscopy 2024; 56:E687-E688. [PMID: 39111756 PMCID: PMC11305864 DOI: 10.1055/a-2361-1361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Affiliation(s)
- Jianzhen Ren
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Silin Huang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Jun Cai
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Bo Li
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Guang Yang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Suhuan Liao
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Ronggang Zhang
- Department of Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
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3
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Ma X, Yang L, Jia Y, Kang Z, Zhang M, Yu D, Jin P. Cholangioscope-assisted evaluation and endoscopic incision of stricture caused by thick mucosal bridge in Crohn's disease. Endoscopy 2024; 56:E745-E746. [PMID: 39151925 PMCID: PMC11329322 DOI: 10.1055/a-2374-8662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/19/2024]
Affiliation(s)
- Xianzong Ma
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA General Hospital, Beijing, China
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Lang Yang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yan Jia
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zilin Kang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Mingjie Zhang
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dongliang Yu
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peng Jin
- Department of Gastroenterology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- Chinese PLA General Hospital, Beijing, China
- Senior Department of Gastroenterology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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Cai J, Huang S, Lu Y, Liao S, Yang G, Li B, Ren J. First report of the use of a digital single-operator cholangioscope for endoscopic direct diverticulitis therapy. Endoscopy 2024; 56:E466-E467. [PMID: 38843823 PMCID: PMC11156496 DOI: 10.1055/a-2316-1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Affiliation(s)
- Jun Cai
- Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Silin Huang
- Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Yangbor Lu
- Gastroenterology and Hepatology, Xiamen Chang Gung Memorial Hospital, Huaqiao University, Xiamen, China
| | - Suhuan Liao
- Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Guang Yang
- Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Bo Li
- Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Jianzhen Ren
- Gastroenterology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
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Hu J, Zheng J, Yang C, Gao X, Guo X, Zheng X. A radiation-free novel approach for intestinal stent placement: the "scope-in-scope" technique. Endoscopy 2024; 56:E313-E314. [PMID: 38593996 PMCID: PMC11003807 DOI: 10.1055/a-2291-9315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Jiaqing Hu
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
- Fujian Medical University Provincial Clinical Medical College, Fuzhou, China
| | - Jinhui Zheng
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Changshun Yang
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Xiang Gao
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Xianbin Guo
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaoling Zheng
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
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6
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Hu J, Zheng J, Yang C, Gao X, Guo X, Zheng X. A radiation-free novel approach for intestinal stent placement: the "scope-in-scope" technique. Endoscopy 2024; 56:632-633. [PMID: 39079524 PMCID: PMC11288661 DOI: 10.1055/a-2324-2108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Affiliation(s)
- Jiaqing Hu
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
- Fujian Medical University Provincial Clinical Medical College, Fuzhou, China
| | - Jinhui Zheng
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Changshun Yang
- Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Xiang Gao
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Xianbin Guo
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaoling Zheng
- Department of Gastrointestinal Endoscopy, Fujian Provincial Hospital, Fuzhou, China
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Feng SJ, Zhou YF, Yang JF, Shen HZ, Cui GX, Zhang XF. Is appendoscope a new option for the treatment of acute appendicitis? World J Gastroenterol 2024; 30:3386-3392. [PMID: 39091716 PMCID: PMC11290393 DOI: 10.3748/wjg.v30.i28.3386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 06/11/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024] Open
Abstract
Acute appendicitis is a common surgical emergency. It is commonly caused by obstruction of the appendiceal lumen due to fecaliths, tumors, or lymphoid hyperplasia. For over a century, appendectomy has been the primary treatment for acute appendicitis. Abraham Groves performed the first open appendectomy in 1883. In 1983, Kurt Semm completed the first laparoscopic appendectomy, heralding a new era in appendectomy. However, appendectomy is associated with certain complications and a rate of negative appendectomies. Studies have suggested controversy over the impact of appendectomy on the development of inflammatory bowel disease and Parkinson's disease, but an increasing number of studies indicate a possible positive correlation between appendectomy and colorectal cancer, gallstones, and cardiovascular disease. With the recognition that the appendix is not a vestigial organ and the advancement of endoscopic te-chnology, Liu proposed the endoscopic retrograde appendicitis therapy. It is an effective minimally invasive alternative for treating uncomplicated acute appendicitis. Our team has developed an appendoscope with a disposable digital imaging system operated through the biopsy channel of a colonoscope and successfully applied it in the treatment of appendicitis. This article provides an overview of the progress in endoscopic treatment for acute appendicitis and offers a new perspective on the future direction of appendiceal disease treatment.
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Affiliation(s)
- Shu-Jiong Feng
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Yi-Feng Zhou
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Jian-Feng Yang
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Hong-Zhang Shen
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Guang-Xing Cui
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
| | - Xiao-Feng Zhang
- Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
- Department of Gastroenterology, Hangzhou Institute of Digestive Diseases, Hangzhou 310000, Zhejiang Province, China
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Chen Z, Li X, Chen J, Zheng W, Li Y, Dai Z, Yao C, Lin F, Chen X. Contrast-Enhanced Ultrasound-Guided Endoscopic Retrograde Appendicitis Treatment-A Pilot Study on the Diagnostic and Therapeutic Efficacy in Uncomplicated Appendicitis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38943425 DOI: 10.1002/jum.16515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/29/2024] [Accepted: 06/06/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE To determine the diagnostic and therapeutic value of contrast-enhanced ultrasound-guided endoscopic retrograde appendicitis treatment (ERAT) in patients with uncomplicated appendicitis. METHODS A retrospective analysis was performed on clinical and ultrasound data collected from 105 pediatric patients with uncomplicated appendicitis between January 2020 and December 2023. The ultrasound findings before and after treatment, as well as postoperative follow-up and recurrence rates, were summarized and analyzed. RESULTS Successful intubation was achieved in 96 patients (91.4%). The conventional ultrasound appendix visualization rate was 39.6% (38/105), while the appendix visualization rate after contrast-enhanced ultrasound-guidance was 75% (72/105). Contrast-enhanced ultrasound revealed various appendiceal morphologic changes in 89 patients, such as twisting, tortuosity, stiffness, rough inner wall, dilated diameter, and narrowing of the lumen. Additionally, local filling defects, which indicated the presence of fecal stones or debris deposition, were noted in 68 patients. No leakage of the contrast agent occurred. Post-treatment evaluation showed improvement in appendiceal diameter, lumen, and filling defects (P < .01). The follow-up rate was 82 of 89 patients (92.1%), all of whom recovered well without a recurrence. The recurrence rate was 7.9% (7/89). Among the patients with recurrences, five patients resolved after medical treatment and two patients recovered after surgical treatment. CONCLUSION Contrast-enhanced ultrasound-guided ERAT for uncomplicated appendicitis is safe and effective. Specifically, the appendix is increased, which facilitates an evaluation of therapeutic effectiveness. ERAT serves as a valuable supplementary modality to determine the need for surgical treatment of acute appendicitis, which is of significant clinical value.
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Affiliation(s)
- Zekun Chen
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Xingcai Li
- Department of Ultrasound, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Jingfang Chen
- Department of Gastroenterology, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Weikun Zheng
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Yaya Li
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Zeyi Dai
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Caifang Yao
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Feng Lin
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
| | - Xiaokang Chen
- Department of Ultrasound, Xiamen Children's Hospital, Children's Hospital of Fudan University at Xiamen, Xiamen, China
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Liu D, Zhang J, Liu B. Endoscopic retrograde appendicitis therapy: current and the future. Gastroenterol Rep (Oxf) 2024; 12:goae037. [PMID: 38887595 PMCID: PMC11181945 DOI: 10.1093/gastro/goae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 06/20/2024] Open
Abstract
This article presents an overview of endoscopic retrograde appendicitis therapy (ERAT), an innovative and minimally invasive treatment for appendicitis with an appendix-preserving manner. Since its initial application in 2009, ERAT has gained significant popularity in China, due to its rapid recovery and minimal risk of complications. The ERAT procedures comprise several steps, including appendiceal orifice access and intubation, appendiceal lumen imaging, decompression and irrigation, fecalith removal, and stenting. ERAT has been used in various forms of complicated appendicitis, such as in pregnant women and children, with continuous improvements in both technique and safety. It has the potential to become the preferred diagnostic and treatment method for appendicitis. Until 2023, over 10,000 ERAT procedures have been successfully conducted in China, and the technique has gained more attention worldwide. However, challenges remain, including training, standardization of ERAT practice, research and technology improvement, enhancing public awareness, and fostering international collaboration. In summary, ERAT can be the standard treatment for appendicitis treatment, which represents a paradigm shift in the conventional clinical practice.
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Affiliation(s)
- Dan Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Jiyu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
| | - Bingrong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China
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Tao L, Wang H, Guo Q, Guo S, Guo X, Liu S. Appendicoscopy using single-operator cholangioscope in the management of acute obstructive appendicitis: a novel alternative (with video). Gastrointest Endosc 2024:S0016-5107(24)00227-X. [PMID: 38593933 DOI: 10.1016/j.gie.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/09/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND AIMS The aim of this study was to investigate the safety and efficacy of appendicoscopy using a single-operator cholangioscope (SOC) for the management of acute obstructive appendicitis. METHODS This study describes 110 cases of acute obstructive appendicitis managed with the use of appendicoscopy between January 2021 and June 2023. The success rate (technical + clinical), procedure time, time to abdominal pain relief according to a visual analog scale score, postoperative length of hospital stay, and adverse event rates were recorded and analyzed. RESULTS The technical success rate of appendicoscopy was 96.4%, and the clinical success rate was 91.8%. The mean ± standard deviation procedure time was 20.9 ± 10 minutes. The abdominal pain score at 6 hours after the procedure was ≤3 (visual analog scale method) in 99.1% of patients. The average length of postoperative hospital stay was 3.5 ± 1.5 days. No adverse events occurred. CONCLUSIONS Appendicoscopy seems to be a feasible and effective alternative therapy for the accurate diagnosis and treatment of acute obstructive appendicitis.
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Affiliation(s)
- Liying Tao
- Digestive Endoscopy Center, Jilin People's Hospital, Jilin, China
| | - Hongguang Wang
- Digestive Endoscopy Center, Jilin People's Hospital, Jilin, China.
| | - Qingmei Guo
- Digestive Endoscopy Center, Jilin People's Hospital, Jilin, China
| | - Sijie Guo
- Digestive Endoscopy Center, Jilin People's Hospital, Jilin, China
| | - Xiang Guo
- Digestive Endoscopy Center, Jilin People's Hospital, Jilin, China
| | - Shizhu Liu
- Digestive Endoscopy Center, Jilin People's Hospital, Jilin, China
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11
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Liu BR. Top tips for endoscopic retrograde appendicitis therapy (with video). Gastrointest Endosc 2024; 99:625-628. [PMID: 38103748 DOI: 10.1016/j.gie.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Bing-Rong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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12
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Bowen H, Ding H. Therapeutic endoscopy and appendiceal lesions - train and evaluate before intervening. Endoscopy 2024; 56:159-160. [PMID: 38290508 DOI: 10.1055/a-2185-3802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Hu Bowen
- Hepatobiliary and Pancreatic Surgery Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huanfei Ding
- Department Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Shi Y, Ullah S, Liu BR. Think Again Before Resecting an Organ: Appendectomy or Endoscopic Retrograde Appendicitis Therapy? Inflamm Bowel Dis 2024; 30:320-321. [PMID: 37676043 DOI: 10.1093/ibd/izad208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Affiliation(s)
- Yang Shi
- From the Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Saif Ullah
- From the Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bing-Rong Liu
- From the Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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14
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Xu Z, Wang L, Ali FS, Shi R, Peng Y. Interventional endoscopy and the appendix: train and assess before intervening. Gastrointest Endosc 2024; 99:304-305. [PMID: 38237969 DOI: 10.1016/j.gie.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Zhenglei Xu
- Department of Gastroenterology, Shenzhen People's Hospital; The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Lisheng Wang
- Department of Gastroenterology, Shenzhen People's Hospital; The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Fasial S Ali
- Gastroenterology, Hepatology, and Nutrition Department, University of Texas Health Science Center, Houston, Texas, USA
| | | | - Yueming Peng
- Department of Nursing, Shenzhen People's Hospital; The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
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15
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Uchima HI, Muñoz-González R, Calm A, Pellisé M. Reply to Bowen et al. Endoscopy 2024; 56:160-161. [PMID: 38290509 DOI: 10.1055/a-2192-2606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Hugo I Uchima
- Gastrointestinal Endoscopy, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Endoscopy Unit, Centro Medico Teknon, Barcelona, Spain
| | - Raquel Muñoz-González
- Gastrointestinal Endoscopy, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Endoscopy Unit, Centro Medico Teknon, Barcelona, Spain
| | - Anna Calm
- Gastrointestinal Endoscopy, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Maria Pellisé
- Hospital Clínic de Barcelona, Centro de Investigación Biomédiaca en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
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16
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Bejjani M, Shrigiriwar A, Ghandour B, Safar B, Khashab MA. Use of a cholangioscope for appendixoscopy and detecting a residual appendiceal adenoma. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:29-30. [PMID: 38261847 PMCID: PMC10793164 DOI: 10.1016/j.vgie.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Video 1Use of a cholangioscope for appendixoscopy and detecting a residual appendiceal adenoma.
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Affiliation(s)
- Michael Bejjani
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Apurva Shrigiriwar
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Bachir Ghandour
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
| | - Bashar Safar
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, Maryland
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Tao L, Wang H, Guo Q. Single-operator cholangioscopy system for management of acute cholecystitis secondary to choledocholithiasis. Endosc Int Open 2023; 11:E1138-E1142. [PMID: 38221948 PMCID: PMC10785000 DOI: 10.1055/a-2201-6871] [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: 08/28/2023] [Accepted: 10/27/2023] [Indexed: 01/16/2024] Open
Abstract
This study aimed to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) + EyeMax (single-operator cholangioscopy system; SOC) (i.e., ERCP+SOC) for the treatment of choledocholithasis-associated acute cholecystitis. Twenty-five patients were evaluated between January 2022 and June 2023. The success rate (technical + clinical), procedure time, postoperative recovery, postoperative length of hospital stay, and complications rates were recorded. The procedure and clinical success rates were 92% (23/25) and 96% (24/25), respectively. The mean procedure time was 36.6±10 minutes (standard deviation [SD]). The average postoperative hospitalization was 2±0.8 days. No adverse events such as bleeding, perforation, or bile leakage occurred. Cholecystitis did not recur during the 2 to 18 months of follow-up. ERCP+SOC may be a feasible, safe, and effective alternative treatment for acute cholecystitis secondary to choledocholithiasis. ERCP+SOC was able to simultaneously resolve both biliary tract and gallbladder problems via natural orifice endoscopy. Its advantages included no skin wound, reduced postoperative pain, quick recovery, limited to no exposure to x-rays, and a short hospital stay.
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Affiliation(s)
- Liying Tao
- Department of Gastroenterology, Jilin People's Hospital, Jilin, China
- Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China
| | - Hongguang Wang
- Department of Gastroenterology, Jilin People's Hospital, Jilin, China
- Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China
| | - Qingmei Guo
- Department of Gastroenterology, Jilin People's Hospital, Jilin, China
- Digestive Endoscopy Center, Jilin People’s Hospital, Jilin, China
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Pata F, Nardo B, Ielpo B, Di Martino M, Murzi V, Di Saverio S, Yang B, Ortenzi M, Pisanu A, Pellino G, Podda M. Endoscopic retrograde appendicitis therapy versus appendectomy or antibiotics in the modern approach to uncomplicated acute appendicitis: A systematic review and meta-analysis. Surgery 2023; 174:1292-1301. [PMID: 37806859 DOI: 10.1016/j.surg.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/09/2023] [Accepted: 08/16/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Endoscopic retrograde appendicitis therapy has been proposed as an alternative strategy for treating appendicitis, but debate exists on its role compared with conventional treatment. METHODS This systematic review was performed on MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE. The last search was in April of 2023. The risk ratio with a 95% confidence interval was calculated for dichotomous variables, and the mean difference with a 95% confidence interval for continuous variables. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (randomized controlled trials) and the Risk of Bias in Non-Randomized Studies of Intervention tool (non-randomized controlled trials). RESULTS Six studies met the eligibility criteria. Four studies compared endoscopic retrograde appendicitis therapy (n = 236 patients) and appendectomy (n = 339) and found no differences in technical success during index admission (risk ratio 0.97, 95% confidence interval [0.92,1.02]). Appendectomy showed superior outcomes for recurrence at 1-year follow-up (risk ratio 11.28, 95% confidence interval [2.61,48.73]). Endoscopic retrograde appendicitis therapy required shorter procedural time (mean difference -14.38, 95% confidence interval [-20.17, -8.59]) and length of hospital stay (mean difference -1.19, 95% confidence interval [-2.37, -0.01]), with lower post-intervention abdominal pain (risk ratio 0.21, 95% confidence interval [0.14,0.32]). Two studies compared endoscopic retrograde appendicitis therapy (n = 269) and antibiotic treatment (n = 280). Technical success during admission (risk ratio 1.11, 95% confidence interval [0.91,1.35]) and appendicitis recurrence (risk ratio 1.07, 95% confidence interval [0.08,14.87]) did not differ, but endoscopic retrograde appendicitis therapy decreased the length of hospitalization (mean difference -1.91, 95% confidence interval [-3.18, -0.64]). CONCLUSION This meta-analysis did not identify significant differences between endoscopic retrograde appendicitis therapy and appendectomy or antibiotics regarding technical success during index admission and treatment efficacy at 1-year follow-up. However, a high risk of imprecision limits these results. The advantages of endoscopic retrograde appendicitis therapy in terms of reduced procedural times and shorter lengths of stay must be balanced against the increased risk of having an appendicitis recurrence at one year.
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Affiliation(s)
- Francesco Pata
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy; General Surgery Unit, Department of Surgery, AO Annunziata, Cosenza, Italy. https://twitter.com/drfrancescopata
| | - Bruno Nardo
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy; General Surgery Unit, Department of Surgery, AO Annunziata, Cosenza, Italy
| | - Benedetto Ielpo
- Hepatobiliary and Pancreatic Surgery Unit, Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Spain. https://twitter.com/IelpoB
| | - Marcello Di Martino
- Division of Hepatobiliary and Liver Transplantation Surgery, Department of Transplantation Surgery, A.O.R.N. Cardarelli, Napoli, Italy. https://twitter.com/MarcDiMartino
| | - Valentina Murzi
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Salomone Di Saverio
- Department of Surgery, "Madonna del Soccorso" Hospital, San Benedetto del Tronto, Italy. https://twitter.com/salo75
| | - Baohong Yang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Monica Ortenzi
- Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy. https://twitter.com/ortenzi_monica
| | - Adolfo Pisanu
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli," Naples; Department of Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain. https://twitter.com/GianlucaPellino
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy.
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Ullah S, Shi Y, Liu BR. Duration of antibiotics in complicated appendicitis. Lancet 2023; 402:1325-1326. [PMID: 37838432 DOI: 10.1016/s0140-6736(23)01564-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/24/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Saif Ullah
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Yang Shi
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Bing-Rong Liu
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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20
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Keane MG, Ghandour B, Voltaggio L, Khashab MA. Appendixoscopy to evaluate a suspected mucinous appendiceal lesion. VideoGIE 2023; 8:178-179. [PMID: 37095837 PMCID: PMC10122069 DOI: 10.1016/j.vgie.2022.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
Video 1Colonoscopy with "appendixoscopy" using a single-operator digital cholangioscope to exclude a mucinous lesion of the appendix.
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Abstract
ABSTRACT Endoscopic retrograde appendicitis therapy (ERAT) has emerged as a promising, non-invasive treatment for acute uncomplicated appendicitis (AUA). ERAT involves cannulation, appendicography, appendiceal stone extraction, appendiceal lumen irrigation, and stent deployment. Recent randomized trials comparing ERAT to laparoscopic appendectomy (LA) have provided promising results in terms of safety and efficacy of ERAT. If the current trajectory of research and development is maintained, ERAT will likely become a strong contender for the standard of care for AUA. Standardized training and credentialing for ERAT, akin to procedures established for endoscopic retrograde cholangiopancreatography, will be pivotal to global adoption of this modality.
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Affiliation(s)
- Suliman Khan
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Faisal S Ali
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas Health Science Center at Houston, TX
| | - Saif Ullah
- Department of Gastroenterology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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22
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Yang B, Podda M, Liu B. Letter to the Editor- Evolving Trends in the Management of Acute Appendicitis During COVID-19 Waves: The ACIE Appy II Study. World J Surg 2023; 47:281-282. [PMID: 36197489 PMCID: PMC9533978 DOI: 10.1007/s00268-022-06777-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Baohong Yang
- Department of Oncology, Weifang People’s Hospital, The First Affiliated Hospital of Weifang Medical University, Weifang, Shandong China ,Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, The 1st street of Jianshe East Road, Zhengzhou, 450000 Henan China
| | - Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital “D. Casula”, Azienda Ospedaliero-Universitaria Di Cagliari, Cagliari, Italy
| | - Bingrong Liu
- Department of Oncology, Weifang People's Hospital, The First Affiliated Hospital of Weifang Medical University, Weifang, Shandong, China. .,Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, The 1st street of Jianshe East Road, Zhengzhou, 450000, Henan, China.
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23
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Podda M. Endoscopic retrograde appendicitis therapy: a starting point for a change of perspective in treating acute appendicitis (and beyond). Endoscopy 2022; 54:755-756. [PMID: 35255524 DOI: 10.1055/a-1759-2859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Monserrato, Italy
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24
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Dhindsa B, Naga Y, Praus A, Saghir SM, Mashiana H, Ramai D, Chandan S, Sayles H, Dhaliwal A, Bhat I, Singh S, Adler D. Endoscopic retrograde appendicitis therapy for acute appendicitis: a systematic review and meta-analysis. Endosc Int Open 2022; 10:E1014-E1019. [PMID: 35845032 PMCID: PMC9286766 DOI: 10.1055/a-1819-8231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/06/2022] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background and study aims Endoscopic retrograde appendicitis therapy (ERAT) is an endoscopic procedure for management of patients with acute appendicitis (AA). In addition to being minimally invasive, it has the added advantages of preservation of appendix and simultaneous inspection of colon. We performed a systematic review and meta-analysis on ERAT in patients with AA.
Methods We conducted a comprehensive search of multiple electronic databases (from inception through January 2022) to identify studies reporting ERAT in AA. The primary outcome was to evaluate the overall clinical and technical success of ERAT. The secondary outcome was to study the total and individual adverse events (AEs). The meta-analysis was performed using Der Simonian and Laird random effect model.
Results Seven studies reporting on 298 patients were included. The majority of the patient population was male (55.3 %), with mean age of 31 ± 12.39 years. The pooled technical success rate was 99.36 % (95 % CI 97.61–100, I2 = 0) and the pooled clinical success rate was 99.29 % (95 % CI 97.48–100, I2 = 0). The pooled AE rate was 0.19 % (95 % CI 0–1.55, I2 = 0). The most common AE was perforation with 0.19 % (95 % CI 0–1.55, I2 = 0). The recurrence rate was 6.01 % (95 % CI 2.9–9.93, I2 = 20.10). Average length of procedure was 41.1 ± 7.16 min. Low heterogeneity was noted in in our meta-analysis.
Conclusions ERAT is a safe procedure with high rates of clinical and technical success in patients with AA. Further randomized controlled trials should be performed to assess the utility of ERAT in AA as compared to laparoscopic appendectomy.
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Affiliation(s)
- Banreet Dhindsa
- University of Nebraska Medical Center, Gastroenterology and Hepatology, Omaha, Nebraska, United States
| | - Yassin Naga
- University of Nevada School Medicine, Internal Medicine, Las Vegas, Nevada, United States
| | - Alexander Praus
- University of Nebraska Medical Center, Department of Internal Medicine, Omaha, Nebraska, United States
| | - Syed Mohsin Saghir
- Creighton University School of Medicine, Division of Gastroenterology and Hepatology, Omaha, Nebraska, United States
| | - Harmeet Mashiana
- University of Nebraska Medical Center, Gastroenterology and Hepatology, Omaha, Nebraska, United States
| | - Daryl Ramai
- University of Utah School of Medicine, Gastroenterology and Hepatology, Salt Lake City, Utah, United States
| | - Saurabh Chandan
- Creighton University School of Medicine, Division of Gastroenterology and Hepatology, Omaha, Nebraska, United States
| | - Harlan Sayles
- University of Nebraska Medical Center, Biostatistics, Omaha, Nebraska, United States
| | - Amaninder Dhaliwal
- McLeod Health, Division of Gastroenterology, Florence, South Carolina, United States
| | - Ishfaq Bhat
- University of Nebraska Medical Center, Gastroenterology and Hepatology, Omaha, Nebraska, United States
| | - Shailender Singh
- University of Nebraska Medical Center, Gastroenterology and Hepatology, Omaha, Nebraska, United States
| | - Douglas Adler
- Centura Health, Center for Advanced Therapeutic Endoscopy, Englewood, Colorado, United States
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Ullah S, Liu BR. Endoscopic full-thickness resection for polyps involving the appendiceal orifice: not yet ready for prime time. Endoscopy 2022; 54:627. [PMID: 35613611 DOI: 10.1055/a-1770-4093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Saif Ullah
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bing-Rong Liu
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou, China
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26
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Schaefer M. Beyond the end: a cholangioscope in the appendix - a new tool for the management of acute appendicitis? Endoscopy 2022; 54:401-402. [PMID: 35172367 DOI: 10.1055/a-1748-4237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Marion Schaefer
- Department of Hepatology and Gastroenterology, Regional University Hospital of Nancy, Nancy, France
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27
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Yang B, Kong L, Ullah S, Zhao L, Liu D, Li D, Shi X, Jia X, Dalal P, Liu B. Endoscopic retrograde appendicitis therapy versus laparoscopic appendectomy for uncomplicated acute appendicitis. Endoscopy 2022; 54:747-754. [PMID: 35021234 PMCID: PMC9329065 DOI: 10.1055/a-1737-6381] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic retrograde appendicitis therapy (ERAT) is a new and minimally invasive technique for the treatment of acute appendicitis. This study aimed to assess the efficacy and clinical outcomes of ERAT versus laparoscopic appendectomy for patients with uncomplicated acute appendicitis. METHODS We adopted propensity score matching (1:1) to compare ERAT and laparoscopic appendectomy in patients with uncomplicated acute appendicitis between April 2017 and March 2020. We reviewed 2880 patients with suspected acute appendicitis, of whom 422 patients with uncomplicated acute appendicitis met the matching criteria (ERAT 79; laparoscopic appendectomy 343), yielding 78 pairs of patients. RESULTS The rate of curative treatment within 1 year after ERAT was 92.1 % (95 % confidence interval [CI] 83.8 % to 96.3 %). The percentage of patients recording visual analog scale values of ≤ 3 for pain at 6 hours after treatment was 94.7 % (95 %CI 87.2 % to 97.9 %) in the ERAT group, which was significantly higher than that in the laparoscopic appendectomy group (83.3 %; 95 %CI 73.5 % to 90.0 %). Median procedure time and median hospital length of stay were significantly lower in the ERAT group compared with the laparoscopic appendectomy group. At 1 year, the median recurrence time was 50 days (interquartile range 25-127) in the ERAT group. The overall adverse event rate was 24.4 % (95 %CI 14.8 % to 33.9 %) in the laparoscopic appendectomy group and 18.4 % (95 %CI 9.7 % to 27.1 %) in the ERAT group, with no significant difference between the two groups. CONCLUSION ERAT was a technically feasible method of treating uncomplicated acute appendicitis compared with laparoscopic appendectomy.
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Affiliation(s)
- Baohong Yang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China,Department of Oncology, Weifang People’s Hospital (The First Affiliated Hospital of Weifang Medical University), Weifang, Shandong, China
| | - Lingjian Kong
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Saif Ullah
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lixia Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Dan Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Deliang Li
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaocan Jia
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Paras Dalal
- Department of Radiology, Harefield Hospital, Harefield, United kingdom
| | - Bingrong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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