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Khan SR, Roy AS, Hossain MB, Nira NH, Islam H. Evaluation of Intradialytic Complications and Protein Catabolic Rate on Maintenance Hemodialysis Patients in Bangladesh. Mymensingh Med J 2024; 33:411-419. [PMID: 38557519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Among patients with chronic kidney disease stage-5 who are treated with dialysis, intradialytic complications commonly occur during routine hemodialysis (HD). It could be either patient related or mechanical. Protein catabolic rate during hemodialysis is a determinant of the mortality. nPCR was aimed to targets according to International guideline. This observational study was conducted in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from January 2020 to December 2020 to compare two groups of nPCR and different value of biochemical parameters. This study was involving all patients and inclusion criteria were patients who underwent routine HD for at least three months. All patients under-went conventional intermittent HD with low-flux dialyser. A total of 179 patients enrolled. Serum albumin, serum calcium, phosphate, hemoglobin and pre-dialysis urea, post dialysis urea were measured from blood sample. The nPCR was calculated by the standard international equation. nPCR value of 14.0% patients was more than 1.0 gm/kg/day and average nPCR (mean±SD) of all patients was 0.903±0.09gm/kg/day and 86.0% patients nPCR was less than 1.0 gm/kg/day. Biochemical parameters were not significantly differing between two groups. The nPCR is an indicator, can help the determination of nutritional status. This study aimed to find out the intradialytic complications, mean value of nPCR and correlation of biochemical parameters among ESRD patients on maintenance hemodialysis.
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Affiliation(s)
- S R Khan
- Dr Suhel Rana Khan, Dialysis Medical Officer, Department of Nephrology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Nira NH, Hoque MR, Khan SR, Ferdausee M, Momo FR, Ara R. Status of Serum Magnesium, Serum Zinc and C-reactive Protein in Hospitalized Patients with Chronic Kidney Disease in Mymensingh Locality. Mymensingh Med J 2024; 33:327-333. [PMID: 38557506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Chronic Kidney Disease (CKD) is an important public health issue, with a leading cause of death and disability around the world. This cross-sectional study was conducted from January 2021 to December 2021 in the department of Biochemistry in Mymensingh Medical College in cooperation with the Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The study was carried out to evaluate the status of serum magnesium, zinc and CRP in patients with CKD not on dialysis for monitoring the disease progression. For this purpose, 110 subjects were included, where 55 Hospitalized CKD patients were considered as Group I and 55 normal healthy individuals as Group II. Study subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. Serum magnesium and zinc were determined by colorimetric method while CRP was measured by CRP-Latex Test (Slide Agglutination Test) from each sample. SPSS windows package, version 21.0 was used to perform the statistical analysis. Statistical significance of difference between Group I and Group II were evaluated by using student's unpaired 't'-test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. Mean age of Group I was 52.65±4.93 and Group II was 51.15±6.32 years. P-value was 0.165 which is statistically insignificant. The mean ±SD of BMI was 24.46±1.84 Kg/m² for Group I and 24.50±1.05 Kg/m² for Group II. P-value was 0.886 which is statistically insignificant. Among the study groups the mean serum magnesium were 2.25±0.17 and 1.95±0.05mg/dl, zinc were 88.64±9.21 and 102.11±12.93μg/dl, CRP were 24.00±16.73 and <6.0±0.00mg/L in Group I and Group II respectively. Analysis showed that, the mean serum magnesium and CRP were significantly increased while serum zinc was significantly decreased in CKD patients in comparison to that of healthy individual. There was negative correlation between serum zinc and CRP. This study was done within the context of the facilities available to us.
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Affiliation(s)
- N H Nira
- Dr Narmin Halim Nira, Biochemist, Mymensingh Medical College Hospital (MMCH), Bangladesh; E-mail:
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Islam H, Salahuddin AZM, Miah MOF, Shanta SP, Hossain MS, Moon MSI, Datta P, Hasib M, Khan SR. Risk Factors of Patients with Postpartum Acute Kidney Injury: An Observational Study. Mymensingh Med J 2024; 33:387-392. [PMID: 38557516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Postpartum acute kidney injury (AKI) is a condition characterized by a sudden and rapid decline in kidney function that occurs shortly after childbirth. Several risk factors may be associated with postpartum acute kidney injury (AKI). Understanding the possible risk factors is essential for timely intervention and improved maternal healthcare. The aim of the study was to assess the risk factors of postpartum acute kidney injury patients. This prospective observational study took place at Mymensingh Medical College Hospital, from March 2020 to April 2021. It was carried out in the Departments of Nephrology and Departments of Obstetrics & Gynecology, where 153 postpartum acute kidney injury (AKI) patients were enrolled through purposive sampling. The study collected data on patient demographics, etiology and presentation. Statistical analysis was conducted using SPSS (Statistical Package for the Social Sciences) version 26.0, with a significance threshold set at p<0.05 for all tests. Among participants, puerperal sepsis (77.8%) and toxemia of pregnancy (58.8%) were prevalent risk factors. Intrauterine death was rare (1.3%). Other risk factors such as postpartum hemorrhage 22.2%, HELLP syndrome 11.1%, and antepartum hemorrhage 15.0% were found. A statistically significant difference in postpartum hemorrhage prevalence (p=0.038) was noted between hemodialysis and non-hemodialysis patients. Puerperal sepsis is the most common risk factor for postpartum acute kidney injury, closely followed by toxemia of pregnancy. Intrauterine death is rare, while postpartum hemorrhage significantly affects subjects, with variations noted between hemodialysis and non-hemodialysis patients.
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Affiliation(s)
- H Islam
- Dr Hasanul Islam, Registrar (Nephrology), Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Nira NH, Hoque MR, Khan SR, Ferdausee M, Momo FR. Status of C-reactive protein, Serum Albumin and Serum Zinc in Hospital Admitted Patients with Chronic Kidney Disease. Mymensingh Med J 2024; 33:1-8. [PMID: 38163766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Chronic Kidney Disease (CKD) is one of the most concerned non-communicable diseases now a day. Multiple complications arise and different biochemical parameters change in this disease. This cross-sectional study was conducted from January to December, 2021 in the Department of Biochemistry, Mymensingh Medical College with the help of the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh. The motive of this study was to explore the status of C-reactive protein (CRP), serum albumin and serum zinc in patients with CKD for monitoring the disease progression. In this study, 110 subjects were included, where 55 Hospital admitted CKD patients act as Group I and 55 normal healthy individuals act as Group II. The subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. In this study, CRP levels, serum albumin and serum zinc were measured. All values were expressed as Mean±SD. All statistical analysis was done by using SPSS (statistical package for social science) windows package version 21.0. Statistical significance of difference between Group I and Group II were evaluated by using Student's unpaired 't'-test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. Mean age of Group I was 52.65±4.93 and Group II was 51.15±6.32. P value was 0.165 which is statistically insignificant. The mean±SD of BMI was 24.46±1.84 for Group I and 24.50±1.05 for Group II. P value was 0.886 which is statistically insignificant. The mean±SD values of CRP were 24.00±16.73mg/L and <6.0±0.00mg/L in Group I and Group II respectively. So, we found significant (p<0.05) increase in CRP levels. The mean±SD values of serum albumin were 3.62±0.26g/dl and 4.16±0.69g/dl in Group I and Group II respectively. We found highly significant (p<0.001) decrease in serum albumin. Among the study groups the mean serum zinc was 88.64±9.21μg/dl and 102.11±12.93μg/dl in Group I and Group II respectively. The mean serum zinc was highly significantly (<0.001) decreased. There was negative correlation between CRP and serum albumin, CRP and serum zinc. There was positive correlation between serum albumin and serum zinc. Analyzing the findings of present study, significant increase in CRP levels, significant decrease in serum albumin and serum zinc were observed in CKD patients.
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Affiliation(s)
- N H Nira
- Dr Narmin Halim Nira, Biochemist, Mymensingh Medical College Hospital (MMCH), Bangladesh; E-mail:
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Malik S, Venugopalan S, Tenorio BG, Khan SR, Loganathan P, Navaneethan U, Mohan BP. Diagnostic accuracy of bowel ultrasonography in patients with inflammatory bowel disease: a systematic review and meta-analysis. Ann Gastroenterol 2024; 37:54-63. [PMID: 38223248 PMCID: PMC10785028 DOI: 10.20524/aog.2024.0842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background Bowel ultrasonography (BUS) is emerging as a promising noninvasive tool for assessing disease activity in inflammatory bowel disease (IBD) patients. We evaluated the diagnostic accuracy of BUS in IBD patients against the gold standard diagnostic method, standard colonoscopy. Methods Major databases were searched from inception to May 2023 for studies on BUS diagnostic accuracy in IBD. Outcomes of interest were pooled sensitivity, specificity, positive (PPV), and negative (NPV) predictive values. Endoscopic confirmation served as ground truth. Standard meta-analysis methods with a random-effects model and I2 statistics were applied. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results Twenty studies (1094 patients) were included in the final analysis. The majority (75%) of studies considered bowel wall thickness >3 mm as abnormal. Endoscopic evaluation was performed between days 3 and 180. The pooled diagnostic accuracy of BUS in IBD was 66% (95% confidence interval [CI] 58-72%; I2=78%), sensitivity was 88.6% (95%CI 85-91%; I2=77%), and specificity 86% (95%CI 81-90%; I2=95%). PPV and NPV were 94% (95%CI 93-96%; I2=25%) and 74% (95%CI 66-80%; I2=95%), respectively. On subgroup analysis, small-intestine contrast-enhanced ultrasonography (SICUS) demonstrated high sensitivity (97%, 95%CI 91-99%; I2=83%), whereas BUS exhibited high specificity (94%, 95%CI 92-96%; I2=0%) and NPV (76%, 95%CI 68-83%; I2=80.9%). Meta-regression revealed a significant relation between side-to-side anastomosis and BUS specificity (P=0.02) and NPV (P=0.004). Conclusion The high diagnostic accuracy of BUS in detecting bowel wall inflammation suggests utilizing regular BUS as the primary modality, with subsequent consideration of SICUS if clinically warranted.
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Affiliation(s)
- Sheza Malik
- Internal Medicine, Rochester General Hospital, NY, USA (Sheza Malik)
| | - Sruthi Venugopalan
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA (Sruthi Venugopalan)
| | | | - Shahab R. Khan
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (Shahab R. Khan)
| | | | | | - Babu P. Mohan
- Gastroenterology and Hepatology, Orlando Gastroenterology PA, Orlando, FL, USA (Babu P. Mohan)
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Khan SR, Roy AS, Hoque MR, Das SK, Hossain MB, Miah MOF, Nira NH, Salahuddin AZM, Islam H, Datta P. Assessment of Dialysis Adequacy Using Small Solute Clearance Indices among Twice versus Thrice Weekly Maintenance Hemodialysis Patients in a Tertiary Care Hospital of Bangladesh. Mymensingh Med J 2024; 33:80-90. [PMID: 38163777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
This observational study was carried out in the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from January 2020 to December 2020. A total of 179 patients were included in this study according to inclusion and exclusion criteria. Informed written consent was taken from each patient. All patients were underwent detail history taking, thorough physical examination and relevant investigations. Data collection was conducted through a structured questionnaire. Collected data were analyzed using the statistical software SPSS 23.0. Mean age ±SD of the study patients was 47.06±14.1 with a majority in age group 41-50 years. Male predominance was observed with a male: female ratio of 2.19:1 and 68.7% male patients. Level of pre-dialysis, post-dialysis urea in the study population was 123.77±26.86mg/dl, 50.27±15.70mg/dl respectively and mean ±SD of Urea Reduction Ratio (URR) in hemodialysis (target >65.0%) was 67.2±1.9. Most of the 8 hours (two times) per week hemolysis patients could not achieve the target value of dialysis adequacy parameters. On the other hand, maximum people in 12 hours (three times) per week hemodialysis group achieved the target value of dialysis adequacy parameters. It is important to calculate Kt/V or URR and individualize the dialysis doses for each patient.
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Affiliation(s)
- S R Khan
- Dr Suhel Rana Khan, Dialysis Medical Officer, Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh; E-mail:
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Hosen MM, Alam MNE, Tonni FS, Khan SR, Maksud MA, Lutfa LN, Ullah AKMA, Begum R, Nahar Q, Quraishi SB. Exploration of Toxic and Essential Metals in Popular Rice Grains of Bangladesh and Associated Human Health Risk Implications. Biol Trace Elem Res 2023:10.1007/s12011-023-03962-z. [PMID: 37989930 DOI: 10.1007/s12011-023-03962-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
In order to evaluate the benefits as well as the impacts of essential and toxic metals regarding human health, the six common rice grains (katarivhog, bashful, banglamoti, najirshail, branded miniket and loose miniket) were collected from four wholesale markets in Dhaka, the capital of Bangladesh, and were analyzed with different atomic absorption spectroscopy (AAS) techniques. The mean concentrations of the toxic metals Pb, Cd, Cr, and As had 0.299 ± 0.017, 0.157 ± 0.012, 1.33 ± 0.084, and 0.120 ± 0.006 mg/kg, respectively, while those of the essential metals Fe, Cu, Zn, Na, Ca, and Mg had 7.90 ± 0.447, 3.11 ± 0.097, 10.6 ± 0.340, 37.4 ± 0.622, 90.1 ± 7.70, and 115.8 ± 1.61 mg/kg, respectively. Among them, the mean concentrations of toxic metals (Pb, Cd, Cr, and As) exceeded the maximum allowable concentration in rice set by the Codex Alimentarius Commission (CAC). Risk assessment of the heavy metals Pb, Cd, Cr, As, Fe, Cu, and Zn showed that their estimated daily intakes were below the daily reference doses for adults. However, Cd and Cr individually were found to have the target hazard quotient value close to 1 (threshold limit), indicating that they alone are capable of potential health hazards from continuous rice consumption, while the hazard index has surpassed three units signifying greater danger associated with the current trend of consumption. A very high chance of developing cancer in the near future is predicted by incremental lifetime carcinogenic risk (ILCR) analysis for continued intake of Cr (ILCR > 1E-03), and a moderate to high risk is predicted for other carcinogenic substances (Pb, Cd, and As) (ILCR in between 1E-03 and 1E-05) with present rice consumption. The contribution of the essential metals to the RNI revealed that Cu from rice contributes more than 100% in most samples, and the overall contribution is in the following order: Cu > Zn > Fe > Mg > Ca > Na. To ensure the safety of staple foods for human health, it ought to be necessary to design a plan to measure the budget of hazardous metals from all sources with proper surveillance by relevant authorities.
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Affiliation(s)
- M Mozammal Hosen
- Analytical Chemistry Laboratory, Chemistry Division, Atomic Energy Center Dhaka, Bangladesh Atomic Energy Commission (BAEC), 4-Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000, Bangladesh
| | - M Nur E Alam
- Analytical Chemistry Laboratory, Chemistry Division, Atomic Energy Center Dhaka, Bangladesh Atomic Energy Commission (BAEC), 4-Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000, Bangladesh.
| | - F S Tonni
- Department of Food and Nutrition, College of Home Economics, University of Dhaka (DU), Shahbag, Dhaka-1000, Bangladesh
| | - S R Khan
- Analytical Chemistry Laboratory, Chemistry Division, Atomic Energy Center Dhaka, Bangladesh Atomic Energy Commission (BAEC), 4-Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000, Bangladesh
| | - M A Maksud
- Analytical Chemistry Laboratory, Chemistry Division, Atomic Energy Center Dhaka, Bangladesh Atomic Energy Commission (BAEC), 4-Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000, Bangladesh
| | - L N Lutfa
- Analytical Chemistry Laboratory, Chemistry Division, Atomic Energy Center Dhaka, Bangladesh Atomic Energy Commission (BAEC), 4-Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000, Bangladesh
| | - A K M Atique Ullah
- Analytical Chemistry Laboratory, Chemistry Division, Atomic Energy Center Dhaka, Bangladesh Atomic Energy Commission (BAEC), 4-Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000, Bangladesh
| | - Rehena Begum
- Department of Food and Nutrition, College of Home Economics, University of Dhaka (DU), Shahbag, Dhaka-1000, Bangladesh
| | - Quamrun Nahar
- Department of Endocrine and Metabolic Disorder, Bangladesh Institute of Research and Rehabilitation in Diabetes (BIRDEM), Shahbag, Dhaka-1000, Bangladesh
| | - Shamshad B Quraishi
- Analytical Chemistry Laboratory, Chemistry Division, Atomic Energy Center Dhaka, Bangladesh Atomic Energy Commission (BAEC), 4-Kazi Nazrul Islam Avenue, Shahbag, Dhaka-1000, Bangladesh
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Mohan BP, Fatima N, Khan SR, Kassab L, Chandan S, Asokkumar R, Valentine JF, Navaneethan U, Kochhar GS, Ma C, Jairath V, Singh S. Early Remission With Induction Therapy Predicts Long-Term Remission in Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2023; 118:2084-2087. [PMID: 37207296 DOI: 10.14309/ajg.0000000000002328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Affiliation(s)
- Babu P Mohan
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake, City, Utah, USA
| | - Noor Fatima
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake, City, Utah, USA
| | - Shahab R Khan
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lena Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Saurabh Chandan
- Gastroenterology & Hepatology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | | | - John F Valentine
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake, City, Utah, USA
| | | | - Gursimran S Kochhar
- Center for Advanced Endoscopy & IBD, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Christopher Ma
- Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Vipul Jairath
- Alimentiv Inc. London, Ontario, Canada
- Gastroenterology, Western University, London, Ontario, Canada
| | - Siddharth Singh
- Gastroenterology, University of California San Diego, La Jolla, California, USA
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Nira NH, Akhter S, Khan SR, Ferdausee M, Momo FR, Zannat KE. Status of Serum Zinc and Albumin in Hospital Admitted Chronic Kidney Disease Patients in Mymensingh Locality. Mymensingh Med J 2023; 32:933-938. [PMID: 37777883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
This cross-sectional study was conducted in the department of Biochemistry in Mymensingh Medical College in cooperation with Nephrology department of Mymensingh Medical College Hospital, Bangladesh from January to December, 2021. The study was carried out to evaluate the status of serum zinc and albumin in patients with CKD not on dialysis for monitoring the disease progression. For this purpose, 110 subjects were included, where 55 Hospital admitted CKD patients were considered as Group I and 55 normal healthy individuals as Group II. Serum zinc and albumin were determined by colorimetric method from each sample. Statistical analysis was performed by SPSS windows package, version 21.0. Among the study groups the mean serum zinc were 88.64±9.21μg/dl and 102.11±12.93μg/dl and serum albumin were 3.62±0.26g/dl and 4.16±0.69g/dl in Group I and Group II respectively. Analysis showed that the mean serum zinc and albumin were highly significantly (p<0.001) decreased in CKD patients in comparison to that of healthy individual. Significant positive correlation was found between serum zinc and albumin.
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Affiliation(s)
- N H Nira
- Dr Narmin Halim Nira, Biochemist, Mymensingh Medical College Hospital, Mymensingh, Bangladesh; E-mail:
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Chandan S, Bapaye J, Khan SR, Mohan BP, Ramai D, Dahiya DS, Bilal M, Draganov PV, Othman MO, Rodriguez Sánchez J, Kochhar GS. Safety and efficacy of underwater versus conventional endoscopic mucosal resection for colorectal polyps: Systematic review and meta-analysis of RCTs. Endosc Int Open 2023; 11:E768-E777. [PMID: 37593155 PMCID: PMC10431976 DOI: 10.1055/a-2117-8327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/20/2023] [Indexed: 08/19/2023] Open
Abstract
Background and study aims Conventional endoscopic mucosal resection (C-EMR) is limited by low en-bloc resection rates, especially for large (> 20 mm) lesions. Underwater EMR (U-EMR) has emerged as an alternative for colorectal polyps and is being shown to improve en-bloc resection rates. We conducted a systematic review and meta-analysis comparing the two techniques. Methods Multiple databases were searched through November 2022 for randomized controlled trials (RCTs) comparing outcomes of U-EMR and C-EMR for colorectal polyps. Meta-analysis was performed to determine pooled proportions and relative risks (RRs) of R0 and en-bloc resection, polyp recurrence, resection time, and adverse events. Results Seven RCTs with 1458 patients (U-EMR: 739, C-EMR: 719) were included. The pooled rate of en-bloc resection was significantly higher with U-EMR vs C-EMR, 70.17% (confidence interval [CI] 46.68-86.34) vs 58.14% (CI 31.59-80.68), respectively, RR 1.21 (CI 1.01-1.44). R0 resection rates were higher with U-EMR vs C-EMR, 58.1% (CI 29.75-81.9) vs 44.6% (CI 17.4-75.4), RR 1.25 (CI 0.99-1.6). For large polyps (> 20 mm), en-bloc resection rates were comparable between the two techniques, RR 1.24 (CI 0.83-1.84). Resection times were comparable between U-EMR and C-EMR, standardized mean difference -1.21 min (CI -2.57 to -0.16). Overall pooled rates of perforation, and immediate and delayed bleeding were comparable between U-EMR and C-EMR. Pooled rate of polyp recurrence at surveillance colonoscopy was significantly lower with U-EMR than with C-EMR, RR 0.62 (CI 0.41-0.94). Conclusions Colorectal U-EMR results in higher en-bloc resection and lower recurrence rates when compared to C-EMR. Both techniques have comparable resection times and safety profiles.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology & Hepatology, Creighton University School of Medicine, Omaha, NE, United States, Omaha, United States
| | - Jay Bapaye
- Department of Medicine, Rochester General Health System, Rochester, NY, United States, Rochester, United States
| | - Shahab R. Khan
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States, Boston, United States
| | - Babu P. Mohan
- Department of Gastroenterology, University of Utah Health, Salt Lake City, UT, United States, Tucson, United States
| | - Daryl Ramai
- Department of Gastroenterology, University of Utah Health, Salt Lake City, UT, United States, Tucson, United States
| | - Dushyant S. Dahiya
- Department of Medicine, Central Michigan University, Mount Pleasant, MI, United States, Saginaw, United States
| | - Mohammad Bilal
- Department of Gastroenterology, Minneapolis VA Health Care System, Minneapolis, MN, United States, Minneapolis, United States
| | - Peter V. Draganov
- Department of Gastroenterology, University of Florida, Gainesville, FL, United States, Gainesville, United States
| | - Mohamed O. Othman
- Department of Gastroenterology, Baylor College of Medicine, Houston, TX, United States, Houston, United States
| | - Joaquin Rodriguez Sánchez
- Endoscopy Unite, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain, Ciudad Real, Spain
| | - Gursimran S. Kochhar
- Division of Gastroenterology, Allegheny Health Network, Pittsburgh, PA, United States, Pittsburgh, United States
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Nira NH, Hoque MR, Khan SR, Ara R, Ferdausee M, Momo FR, Zannat KE, Afrin A. Status of Serum Calcium and Magnesium in Hospital Admitted Chronic Kidney Disease Patients in Mymensingh Locality of Bangladesh. Mymensingh Med J 2023; 32:627-632. [PMID: 37391950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
The study was designed to evaluate the serum calcium and magnesium levels in hospitalized patients with Chronic Kidney Disease (CKD). This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College (MMC), Bangladesh with the help of the Department of Nephrology, Mymensingh Medical College Hospital, Bangladesh from the period of January 2021 to December 2021. The subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. A total of 110 subjects were included in this study. Among them, 55 were diagnosed CKD patients denoted as Group I and 55 were normal healthy individuals denoted as Group II. The subjects were briefed and written consents were taken. Under aseptic precaution 5.0ml of venous blood was collected from median cubital vein. Analyses were carried out in the Department of Biochemistry, Mymensingh Medical College and serum calcium and magnesium levels were measured. All values were expressed as Mean±SD. All statistical analysis was done by using SPSS (statistical package for social science) windows package version 21.0. Statistical significance of difference between Group I and Group II were evaluated by using Student's unpaired 't' test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. The mean±SD values of serum calcium were 8.15±0.54mg/dl and 9.80±0.50mg/dl and serum magnesium were 2.25±0.17mg/dl and 1.95±0.50mg/dl in Group I and Group II respectively. We found mean serum calcium was highly significantly (<0.001) decreased and serum magnesium was highly significantly increased (<0.001) in CKD patients in comparison to that of healthy individual.
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Affiliation(s)
- N H Nira
- Dr Narmin Halim Nira, Biochemist, Mymensingh Medical College Hospital, Mymensingh, Bangladesh; E-mail:
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Mohan BP, Loganathan P, Khan SR, Garg G, Muthusamy A, Ponnada S, Pasam RT, Chandan S, Tuteja A. Fecal microbiota transplant delivered via invasive routes in irritable bowel syndrome: A systematic review and meta-analysis of randomized controlled trials. Indian J Gastroenterol 2023; 42:315-323. [PMID: 37247177 PMCID: PMC10225764 DOI: 10.1007/s12664-023-01373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS Irritable bowel syndrome (IBS) results in significant loss of quality of life. Management guidelines do not recommend fecal microbiota transplant (FMT) for IBS based on weak evidence as refined data is lacking. We performed a systematic review and meta-analysis to ascertain the pooled clinical outcomes of FMT in IBS, delivered via invasive routes. METHODS Multiple databases were searched through January 2023 to identify studies that reported on FMT treatment in IBS by invasive routes. Standard meta-analysis methodology using the random-effects model was used. Heterogeneity was assessed by I2% and 95% predication interval. RESULTS Five studies were included. As many as 377 IBS patients were assessed, of which 238 received FMT and 139 received placebo. One study used nasojejunal tubes, one esophagogastroduodenoscopy and three colonoscopy for FMT delivery. FMT via colonoscopy was performed as a one-time procedure instilled into the cecum. Two studies used 30 g of stool from a single universal donor and one study used 50-80 g of pooled donor feces. The pooled odds ratio of improvement in IBS symptoms with FMT was significantly better as compared to that of placebo OR = 2.9 (95% CI [1.6-5.2, I2 = 62%, p < 0.001]). This was true for studies that exclusively used colonoscopy (OR = 2.1 [1.1-4.2, p = 0.04]). In the FMT arm, 10 patients (10.6%) reported abdomen pain and worsening of symptoms with bloating and six patients (6.3%) reported diarrhea. CONCLUSION FMT delivered via invasive routes, especially colonoscopy, demonstrated significant improvement in IBS symptoms. A single FMT consisting of 30 g or more of single universal donor feces instilled into the cecum is the predominant modality.
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Affiliation(s)
- Babu P Mohan
- Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Utah Health School of Medicine, 30 N 1900 E SOM 4R118, Salt Lake City, UT, 84132, USA.
| | | | - Shahab R Khan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gauri Garg
- Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Utah Health School of Medicine, 30 N 1900 E SOM 4R118, Salt Lake City, UT, 84132, USA
| | | | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Medical Center, Roanoke, VA, USA
| | | | - Saurabh Chandan
- Gastroenterology and Hepatology, CHI Creighton School of Medicine, Omaha, NE, USA
| | - Ashok Tuteja
- Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Utah Health School of Medicine, 30 N 1900 E SOM 4R118, Salt Lake City, UT, 84132, USA
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Nira NH, Akhter S, Khan SR, Ara R, Ferdausee M, Afrin A, Zannat KE, Tabassum T, Momo FR, Miah OF. Serum Albumin and C-reactive protein in Hospital Admitted Patients with Chronic Kidney Disease. Mymensingh Med J 2023; 32:307-312. [PMID: 37002739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Adequate knowledge about the causes of chronic kidney disease and their potential prevention can improve poor clinical outcome in chronic kidney disease (CKD) patients. The study was designed to evaluate the serum albumin and C-reactive protein (CRP) levels in hospitalized patients with Chronic Kidney Disease. This cross-sectional study was carried out in the Department of Biochemistry, Mymensingh Medical College, Mymensingh, Bangladesh with the collaboration of the Department of Nephrology, Mymensingh Medical College Hospital, Mymensingh, from January 2021 to December 2021. The subjects were selected on the basis of inclusion and exclusion criteria by purposive and convenient sampling method. A total of 110 subjects were included in this study. Among them, 55 were diagnosed CKD patients denoted as Group I and 55 were normal healthy individuals denoted as Group II. In this study, serum albumin and CRP levels were measured. All values were expressed as Mean±SD. All statistical analysis was done by using SPSS (statistical package for social science) windows package version 21.0. Statistical significance of difference between Group I and Group II were evaluated by using student's unpaired 't'-test and the significance was defined as p<0.05. Correlation was done by using Pearson's correlation coefficient test. Mean age of Group I was 52.65±4.93 and Group II was 51.15±6.32 (p=0.165). The mean±SD of BMI was 24.46±1.84 for Group I and 24.50±1.05 for Group II (p=0.886). The mean±SD values of serum albumin were 3.62±0.26g/dl and 4.16±0.69g/dl in Group I and Group II respectively. We found highly significant (p<0.001) decrease in serum albumin. The mean±SD values of CRP were 24.00±16.73mg/L and <6.0±0.00mg/L in Group I and Group II respectively. So, we found significant (p<0.05) increase in CRP levels. There was negative correlation between serum albumin and CRP. Analyzing the findings of this study, significant decrease in serum albumin and significant increase in CRP levels were observed in CKD patients.
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Affiliation(s)
- N H Nira
- Dr Narmin Halim Nira, Biochemist, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Chandan S, Deliwala S, Khan SR, Mohan BP, Dhindsa BS, Bapaye J, Goyal H, Kassab LL, Kamal F, Sayles HR, Kochhar GS, Adler DG. EUS-guided versus percutaneous liver biopsy: A comprehensive review and meta-analysis of outcomes. Endosc Ultrasound 2023; 12:171-180. [PMID: 36204798 PMCID: PMC10237604 DOI: 10.4103/eus-d-21-00268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/28/2022] [Indexed: 05/07/2023] Open
Abstract
EUS-guided liver biopsy (EUS-LB) has gained momentum in recent years, especially with availability of newer needle designs. Given the emerging comparative data on EUS-LB with second-generation needles and percutaneous LB (PC-LB), we conducted a systematic review and meta-analysis to compare the safety and efficacy of the two techniques. We searched multiple databases from inception through November 2021 to identify studies comparing outcomes of EUS-LB and PC-LB. Pooled estimates were calculated using a random-effects model, and the results were expressed in terms of pooled proportions and odds ratio (OR) along with relevant 95% confidence intervals (CIs). Five studies with 748 patients were included in the final analysis. EUS-LB was performed in 276 patients and PC-LB in 472 patients. Across all studies, PC-LB had an overall higher diagnostic accuracy than EUS-LB, 98.6% confidence interval (CI: 94.7-99.7) versus 88.3% (49.6-98.3), OR: 1.65, P = 0.04. On assessing data from randomized controlled trials, there was no difference between the two. While pooled diagnostic adequacy and overall adverse events were not significantly different between PC-LB and EUS-LB, the former was superior in terms of the mean number of complete portal tracts (CPT) and total specimen length. PC-LB and EUS-LB produce similar results. PC-LB allows obtaining longer samples and more CPT. Further studies are needed to see if these trends hold up as more providers begin to perform EUS-LB.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA
| | - Smit Deliwala
- Department of Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | - Shahab R. Khan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Banreet S. Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Hemant Goyal
- Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, USA
| | - Lena L. Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, California, USA
| | - Harlan R. Sayles
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gursimran S. Kochhar
- Division of Gastroenterology, Hepatology and Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy, Centura Health, Porter Adventist Hospital, Denver, Colorado, USA
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Mohan BP, Madhu D, Reddy N, Chara BS, Khan SR, Garg G, Kassab LL, Muthusamy AK, Singh A, Chandan S, Facciorusso A, Mangiavillano B, Repici A, Adler DG. Diagnostic accuracy of EUS-guided fine-needle biopsy sampling by macroscopic on-site evaluation: a systematic review and meta-analysis. Gastrointest Endosc 2022; 96:909-917.e11. [PMID: 35932815 DOI: 10.1016/j.gie.2022.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Assessment of EUS-guided fine-needle tissue acquisition by macroscopic on-site evaluation (MOSE) is gathering attention. Studies report good diagnostic parameters with MOSE; however, the overall data are limited. We conducted this systematic review and meta-analysis to report on the pooled diagnostic assessment parameters of EUS-guided tissue acquisition by MOSE using fine-needle biopsy sampling (FNB). METHODS Multiple databases were searched (from inception to December 2021), and studies that reported on the diagnostic assessment of EUS-guided tissue acquisition by MOSE were selected. Pooled diagnostic accuracy, sensitivity, specificity, and positive and negative predictive values were calculated by standard meta-analysis methods following the random-effects model. Heterogeneity was assessed by I2 statistics. RESULTS Fourteen studies were included in the analysis, and 1508 lesions were biopsy sampled in 1489 patients undergoing EUS-guided tissue acquisition. MOSE definition included a visible core of tissue with opacity and "wormlike" features of adequate size and length (≥4 mm). The pooled accuracy of FNA and/or FNB specimens in yielding a pathologic diagnosis by MOSE was 91.3% (95% confidence interval [CI], 88.6-93.3; I2 = 66%), pooled sensitivity was 91.5% (95% CI, 88.6-93.6; I2 = 66%), pooled specificity was 98.9% (95% CI, 96.6-99.7; I2 = 80%), pooled positive predictive value was 98.8% (95% CI, 97.4-99.5; I2 = 33%), and pooled negative predictive value was 55.5% (95% CI, 46.9-63.9; I2 = 95%). Subgroup analyses by newer-generation FNB needles demonstrated similar pooled rates, with minimal adverse events (2.5%; 95% CI, 1.5-3.9; I2 = 21%). CONCLUSIONS Excellent pooled diagnostic accuracy parameters were demonstrated in EUS-guided tissue acquisition by FNB using the MOSE method.
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Affiliation(s)
- Babu P Mohan
- Department of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Deepak Madhu
- Department of Gastroenterology, Caritas Hospital, Kottayam, Kerala, India
| | - Nitin Reddy
- Department of Internal Medicine, PSG Institute of Medical Science, Coimbatore, Tamil Nadu, India
| | - Beatriz Sordi Chara
- Department of Medicine, University of Joinville, Joinville, Santa Catarina, Brazil
| | - Shahab R Khan
- Department of Internal Medicine, Brigham's & Children Hospital, Harvard University, Boston, Massachusetts, USA
| | - Gauri Garg
- Department of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Arun Kumar Muthusamy
- Department of Gastroenterology, Cedar Valley Medical Specialists, Waterloo, Iowa, USA
| | - Achintya Singh
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Saurabh Chandan
- Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA
| | | | - Benedetto Mangiavillano
- Department of Gastroenterology, Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Humanitas University, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Humanitas Clinical and Research Center, Milan, Italy
| | - Douglas G Adler
- Department of Gastroenterology, Center for Advanced Therapeutic Endoscopy, Denver, Colorado, USA
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Chandan S, Bapaye J, Khan SR, Deliwala S, Mohan BP, Ramai D, Dhindsa BS, Goyal H, Kassab LL, Aziz M, Kamal F, Facciorusso A, Adler DG. Safety and efficacy of liquid nitrogen spray cryotherapy in Barrett's neoplasia - a comprehensive review and meta-analysis. Endosc Int Open 2022; 10:E1462-E1473. [PMID: 36397870 PMCID: PMC9666080 DOI: 10.1055/a-1906-4967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/20/2022] [Indexed: 10/17/2022] Open
Abstract
Background and study aims Barrett's esophagus (BE) is a precursor condition to esophageal adenocarcinoma (EAC), resulting in transformation of the squamous epithelium of distal esophagus to columnar-lined epithelium with intestinal metaplasia (IM). Liquid nitrogen spray cryotherapy (LNSC) is a non-contact method of BE eradication and has been used both as primary and salvage therapy. We conducted a systematic review and meta-analysis to assess the safety and efficacy of LNSC. Methods We searched multiple databases from inception through December 2021 to identify studies on use of LNSC for Barrett's neoplasia. Pooled estimates were calculated using random-effects model and results were expressed in terms of pooled proportions with relevant 95 % confidence intervals (CIs) of complete eradication (CE) of dysplasia(D), high grade dysplasia (HGD) and IM. Results Fourteen studies with 707 patients were included in our final analysis. Overall pooled rates of CE-D, CE-HGD and CE-IM were 80.8 % (CI 77.4-83.8; I 2 62), 90.3 % (CI 85.2-93.7; I 2 33) and 55.8 % (CI 51.7-59.8; I 2 73) with follow up ranging from 4.25 months to 69.7 months. In patients with follow up beyond 24 months, the rates of CE-D and CE-IM were 83.6 % (CI 77.6-88.2; I 2 60) and 54.7 % (CI 47.6-61.6; I 2 81). Among LNSC naïve patients with prior history of endoscopic resection, the rates were 79.9 % (CI 73.3-85.2; I 2 50) and 67.1 % (CI 59.5-73.8; I 2 0). Pooled rate of therapeutic failures, defined as lack of response to LNSC therapy, was 23.6 % (CI 19.4-28.3; I 2 73). Post LNSC strictures and perforation pooled rates were 4 % and 0.8 %, respectively, which are similar to those previously reported for RFA. Conclusions Our analysis suggests that liquid nitrogen spray cryotherapy is an acceptable treatment for BE in both ablation naïve and experienced patients.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, New York, United States
| | - Shahab R. Khan
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Smit Deliwala
- Internal Medicine, Hurley Medical Center, Flint, Michigan, United States
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Banreet S. Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Hemant Goyal
- Department of Gastroenterology, The Wright Center for Graduate Medical Education, Scranton, Pennsylvania, Unites States
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, Ohio, United States
| | - Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, California, United States
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Douglas G. Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, Colorado, United States
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Chandan S, Deliwala S, Khan SR, Ramai D, Mohan BP, Bilal M, Facciorusso A, Kassab LL, Kamal F, Dhindsa B, Perisetti A, Adler DG. Advanced Endoscopic Resection Techniques in Cirrhosis-A Systematic Review and Meta-Analysis of Outcomes. Dig Dis Sci 2022; 67:4813-4826. [PMID: 34993682 DOI: 10.1007/s10620-021-07364-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/08/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS While safety and effectiveness of advanced endoscopic resection techniques such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) has been well established in general population, data regarding their utility in patients with cirrhosis is limited. METHODS We searched multiple databases from inception through July 2021 to identify studies that reported on outcomes of EMR and/or ESD in patients with cirrhosis. Meta-analysis was performed to determine pooled rates of immediate and delayed bleeding, perforation, death as well as rates of successful en bloc and R0 resection. Pooled relative risk (RR) was calculated for each outcome between patients with and without cirrhosis. RESULTS Ten studies with a total of 3244 patients were included in the final analysis. Pooled rates of immediate & delayed bleeding, perforation, and death during EMR and/or ESD in patients with cirrhosis were 9.5% (CI 4.0-21.1), 6.6% (CI 4.2-10.3), 2.1% (CI 1.1-3.9) and 0.6% (CI 0.2-1.7), respectively. Pooled rates of successful en bloc and R0 resection were 93% (CI 85.9-96.7) and 90.8% (CI 86.5-93.8), respectively. While incidence of immediate bleeding was higher in patients with cirrhosis, there was no statistically significant difference in any of the other outcomes between the patient groups. CONCLUSIONS Our study shows that performing EMR and ESD for gastrointestinal lesions in patients with cirrhosis is both safe and effective. The risks of procedural complications parallel those reported in general population.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Smit Deliwala
- Internal Medicine, Hurley Medical Center, Flint, MI, USA
| | - Shahab R Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mohammad Bilal
- Division of Gastroenterology, University of Minnesota & Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | | | - Faisal Kamal
- Division of Gastroenterology, University of California-San Francisco, San Francisco, CA, USA
| | - Banreet Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA.
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Adventist Hospital, Denver, CO, USA.
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Islam MA, Mohammed T, Mamoon TB, Chowdhury NH, Khan SR, Rahman ML. Hemithyroidectomy in the Treatment of Papillary Thyroid Carcinoma: A Prospective Study of 300 Patients. Mymensingh Med J 2022; 31:1013-1019. [PMID: 36189546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The correct approach to treat low-risk intra thyroidal papillary thyroid carcinoma (PTC) is still controversial. The traditional paradigm of treating all patients with thyroid cancer with total thyroidectomy, radioactive iodine and suppressive thyroid hormone therapy is no longer suitable. Many authors advocate unilateral thyroidectomy to minimize perioperative morbidity. The purpose of this study was to determine an effective treatment strategy for patients with small unilateral papillary thyroid carcinoma in a low risk group. This is a prospective study of 300 patients who were diagnosed as papillary thyroid carcinoma by preoperative FNAC or postoperative histopathology. The age of the patients' was ranged between 15 to 45 years. The criteria were: tumor ≤4cm, unilateral involvement, cytological non-aggressive subtype, absence of lymph node (LN) involvement and extra thyroidal extension (ETE) on ultrasonography (USG) and absence of clinical distant metastases. Duration of the study period was 30 years from 1989 to 2019. The study was conducted in tertiary care hospital in Bangladesh. All patients had undergone hemi thyroidectomy and followed up by a median period of 25 months (range, 6 to 166 months). Following hemithyroidectomy, among 300 patients, 267 patients (89.0%) did not show any recurrence of disease. Thirty three (33) patients (11.0%) came with locoregional recurrence of disease in clinical and USG findings without any distant metastasis. Maximum patients were between the ages 31-40 year followed by 21-30 years. Female was out number male in the ratio. Though further large scale study should require to determine the optimal treatment option for low risk PTC, but this study can lead to a result that hemi thyroidectomy is now-a-days a better surgical option for PTC even up to tumor size of ≤4cm.
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Affiliation(s)
- M A Islam
- Professor Md Ashraful Islam, Professor and Head, Department of Otolaryngology-Head & Neck Surgery, Bangladesh Medical College, Dhaka, Bangladesh; E-mail:
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Chandan S, Dhindsa BS, Khan SR, Deliwala S, Kassab LL, Mohan BP, Chandan OC, Loras C, Shen B, Kochhar GS. Endoscopic Stenting in Crohn's Disease-related Strictures: A Systematic Review and Meta-analysis of Outcomes. Inflamm Bowel Dis 2022:6650011. [PMID: 35880681 DOI: 10.1093/ibd/izac153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic progressive condition that is complicated by intestinal or colonic stricture in nearly 30% of cases within 10 years of the initial diagnosis. Endoscopic balloon dilation (EBD) is associated with a risk of perforations and recurrence rates of up to 60% at 5 years. Endoscopic stenting has been used as an alternative to EBD, but data on its safety and efficacy are limited. We conducted a systematic review and meta-analysis to assess the outcomes of endoscopic stenting in CD-related strictures. METHODS A systematic and detailed search was run in January 2022 with the assistance of a medical librarian for studies reporting on outcomes of endoscopic stenting in CD-related strictures. Meta-analysis was performed using random-effects model, and results were expressed in terms of pooled proportions along with relevant 95% confidence intervals (CIs). RESULTS Nine studies with 163 patients were included in the final analysis. Self-expanding metal stents (SEMS) including both partial and fully covered were used in 7 studies, whereas biodegradable stents were used in 2 studies. Pooled rate of clinical success and technical success was 60.9% (95% CI, 51.6-69.5; I2 = 13%) and 93% (95% CI, 87.3-96.3; I2 = 0%), respectively. Repeat stenting was needed in 9.6% of patients (95% CI, 5.3-16.7; I2 = 0%), whereas pooled rate of spontaneous stent migration was 43.9% (95% CI, 11.4-82.7; I2 = 88%). Pooled incidence of overall adverse events, proximal stent migration, perforation, and abdominal pain were 15.7%, 6.4%, 2.7%, and 17.9%, respectively. Mean follow-up period ranged from 3 months to 69 months. DISCUSSION Endoscopic stenting in CD-related strictures is a safe technique that can be performed with technical ease, albeit with a limited clinical success. Postprocedure abdominal pain and proximal stent migration are some of the common adverse events reported.
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Affiliation(s)
- Saurabh Chandan
- Department of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Banreet S Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shahab R Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Smit Deliwala
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
| | | | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
| | - Ojasvini C Chandan
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Childrens Hospital of Omaha, Omaha, NE, USA
| | - Carme Loras
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain
| | - Bo Shen
- Center for Ileal Pouch Disorders, Columbia University Irving Medical Center-New York Presbyterian Hospital, NY, USA
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
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Hussain I, Ishrat S, Aravamudan VM, Khan SR, Mohan BP, Lohan R, Abid MB, Ang TL. Mesenteric panniculitis does not confer an increased risk for cancers: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29143. [PMID: 35512070 PMCID: PMC9276205 DOI: 10.1097/md.0000000000029143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 03/03/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Mesenteric panniculitis (MP) is a non-specific, localized inflammation at the mesentery of small intestines which often gets detected on computed tomography. An association with malignant neoplasms remains unclear. We performed a systematic review and meta-analysis to examine the association of malignancy with MP. METHODS MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched for articles published from inception to 2020 that evaluated the association of malignant neoplasms with MP in comparison with control groups. Using random-effects method, a summary odds ratio (OR) estimate with 95% confidence intervals for malignant neoplasms in MP was estimated. RESULTS Four case-control studies reporting data on 415 MP patients against 1132 matched-controls met inclusion criteria and were analyzed. The pooled OR for finding a malignant neoplasm in patients with MP was 0.907 (95% CI: 0.688-1.196; P = .489). The heterogeneity was mild and non-significant. Also, there was no heightened risk of any specific type of malignancy with MP. Three more case-series with unmatched-control groups (MP: 282, unmatched-controls: 17,691) were included in a separate analysis where the pooled OR of finding a malignant neoplasm was 2.963 (95% CI: 1.434-6.121; P = .003). There was substantial heterogeneity in this group. CONCLUSION This meta-analysis of matched controlled studies proves absence of any significant association of malignant neoplasms with MP. Our study also demonstrates that the putative association of malignancy with MP is mainly driven by uncontrolled studies or case-series.
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Affiliation(s)
- Ikram Hussain
- Division of Gastroenterology, Department of Medicine, Woodlands Health Campus, Singapore
| | | | | | - Shahab R. Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Babu P. Mohan
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, UT
| | - Rahul Lohan
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
| | - Muhammad Bilal Abid
- Divisions of Infectious Diseases & Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, SingHealth, Singapore
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21
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Chandan S, Khan SR, Deliwala S, Mohan BP, Ramai D, Chandan OC, Facciorusso A. Postvaccination SARS-CoV-2 infection among healthcare workers: A systematic review and meta-analysis. J Med Virol 2022; 94:1428-1441. [PMID: 34783055 PMCID: PMC8661690 DOI: 10.1002/jmv.27457] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 01/19/2023]
Abstract
Healthcare workers (HCWs) remain on the front line of the battle against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) infection and are among the highest groups at risk of infection during this raging pandemic. We conducted a systematic review and meta-analysis to assess the incidence of postvaccination SARS-CoV-2 infection among vaccinated HCWs. We searched multiple databases from inception through August 2021 to identify studies that reported on the incidence of postvaccination SARS-CoV-2 infection among HCWs. Meta-analysis was performed to determine pooled proportions of COVID-19 infection in partially/fully vaccinated as well as unvaccinated individuals. Eighteen studies with 228 873 HCWs were included in the final analysis. The total number of partially vaccinated, fully vaccinated, and unvaccinated HCWs were 132 922, 155 673, and 17 505, respectively. Overall pooled proportion of COVID-19 infections among partially/fully vaccinated and unvaccinated HCWs was 2.1% (95% confidence interval [CI] 1.2-3.5). Among partially vaccinated, fully vaccinated and unvaccinated HCWs, pooled proportion of COVID-19 infections was 2.3% (CI 1.2-4.4), 1.3% (95% CI 0.6-2.9), and 10.1% (95% CI 4.5-19.5), respectively. Our analysis shows the risk of COVID-19 infection in both partially and fully vaccinated HCWs remains exceedingly low when compared to unvaccinated individuals. There remains an urgent need for all frontline HCWs to be vaccinated against SARS-CoV-2 infection.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and HepatologyCHI Creighton University Medical CenterOmahaNebraskaUSA
| | - Shahab R. Khan
- Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Smit Deliwala
- Department of Internal MedicineInternal Medicine, Hurley Medical CenterFlintMichiganUSA
| | - Babu P. Mohan
- Division of Gastroenterology and HepatologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Daryl Ramai
- Division of Gastroenterology and HepatologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Ojasvini C. Chandan
- Division of Pediatric GastroenterologyHepatology and Nutrition, Children's Hospital of OmahaOmahaNebraskaUSA
| | - Antonio Facciorusso
- Department of Surgical and Medical SciencesGastroenterology UnitUniversity of FoggiaFoggiaItaly
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22
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Mohan BP, Facciorusso A, Khan SR, Madhu D, Kassab LL, Ponnada S, Chandan S, Crino SF, Kochhar GS, Adler DG, Wallace MB. Pooled diagnostic parameters of artificial intelligence in EUS image analysis of the pancreas: A descriptive quantitative review. Endosc Ultrasound 2022; 11:156-169. [PMID: 35313417 PMCID: PMC9258019 DOI: 10.4103/eus-d-21-00063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
EUS is an important diagnostic tool in pancreatic lesions. Performance of single-center and/or single study artificial intelligence (AI) in the analysis of EUS-images of pancreatic lesions has been reported. The aim of this study was to quantitatively study the pooled rates of diagnostic performance of AI in EUS image analysis of pancreas using rigorous systematic review and meta-analysis methodology. Multiple databases were searched (from inception to December 2020) and studies that reported on the performance of AI in EUS analysis of pancreatic adenocarcinoma were selected. The random-effects model was used to calculate the pooled rates. In cases where multiple 2 × 2 contingency tables were provided for different thresholds, we assumed the data tables as independent from each other. Heterogeneity was assessed by I2% and 95% prediction intervals. Eleven studies were analyzed. The pooled overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 86% (95% confidence interval [82.8–88.6]), 90.4% (88.1–92.3), 84% (79.3–87.8), 90.2% (87.4–92.3) and 89.8% (86–92.7), respectively. On subgroup analysis, the corresponding pooled parameters in studies that used neural networks were 85.5% (80–89.8), 91.8% (87.8–94.6), 84.6% (73–91.7), 87.4% (82–91.3), and 91.4% (83.7–95.6)], respectively. Based on our meta-analysis, AI seems to perform well in the EUS-image analysis of pancreatic lesions.
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Affiliation(s)
- Babu P Mohan
- Department of Gastroenterology and Hepatology, University of Utah, Salt Lake City, Utah, USA
| | | | - Shahab R Khan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepak Madhu
- Department of Gastroenterology, Aster MIMS, Calicut, Kerala, India
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suresh Ponnada
- Department of Internal Medicine, Roanoke Medical Center, Roanoke, Virginia, USA
| | - Saurabh Chandan
- Department of Gastroenterology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Stefano F Crino
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G. B. Rossi University Hospital, Verona, Italy
| | - Gursimran S Kochhar
- Department of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Wallace
- Department of Gastroenterology and Hepatology, Sheikh Shahkbout Medical City, Abu Dhabi, UAE
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23
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Cader FA, Haq MM, Khan SR. Impact of the COVID-19 pandemic on cardiology services in the second year at a South Asian cardiac centre. Eur Heart J 2022. [PMCID: PMC9383361 DOI: 10.1093/eurheartj/ehab849.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Background Little has been reported on the impact of the COVID-19 pandemic and the new delta variant, on cardiology services and catheterization volumes in South Asia, during the second year of the pandemic. Purpose We aimed to assess this impact during the second year of the pandemic on cardiology services, procedures and catheterization volumes at a tertiary cardiac centre in Bangladesh. Methods Data on patient visits (outpatient and emergency), admissions, procedures and catheterization volumes were collected for January to June 2020 and 2021 via hospital electronic records. Comparisons for each corresponding month were made between 2021 and 2020. The differences were expressed as a percentage (%Δ). Results Trends showed that admissions in cardiology and cardiac surgery units, outpatient visits, procedures and cardiac catheterization volumes had reached almost pre-pandemic levels in the first quarter of 2021, as compared to 2020. However, ER visits showed >50% reductions in February (Δ-58.7%) and March (Δ -51.9%) 2021, compared to 2020. Admissions and procedures showed a steep decline from March to April 2021, coinciding with the COVID19 surge owing to the Delta variant. A gradual increase in numbers of admissions, patient visits, and procedures were seen in May and June 2021, as compared with corresponding months in 2020. In terms of catheterization volumes, a sharp decline was seen in angiographies and percutaneous coronary intervention (PCI) from March to April 2021, similar to 2020. Cath lab procedures showed an increasing trend in May-June 2021, and were greater in numbers, compared to corresponding volumes in 2020 [May: Δ+36.9%; June: Δ+33.2% in 2021]. A greater increase was seen for PCI (May Δ+ 46.8%; June Δ+367%) than angiographies (May Δ+32.5%; June Δ+32.5%). Conclusion Cardiology services and cath lab volumes had reached almost pre-pandemic levels in January and February 2021. The surge caused by the delta variant resulted in reduced admissions, outpatient and cath lab volumes beginning from April 2021, however numbers remained greater in 2021 than corresponding months in March-June 2020, possibly indicating an adaptation of the healthcare system to the prevailing pandemic.
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Affiliation(s)
- F A Cader
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | - M M Haq
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | - S R Khan
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
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Mohan BP, Madhu D, Khan SR, Kassab LL, Ponnada S, Chandan S, Facciorusso A, Crino SF, Barresi L, McDonough S, Adler DG. Intracystic Glucose Levels in Differentiating Mucinous From Nonmucinous Pancreatic Cysts: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2022; 56:e131-e136. [PMID: 33731599 DOI: 10.1097/mcg.0000000000001507] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mucinous pancreatic cysts are well reported to transform into pancreatic adenocarcinoma, whereas nonmucinous cysts are mostly benign with low risk for malignant transformation. Nonsurgical methods of differentiating mucinous and nonmucinous pancreatic cysts are challenging and entail a multi investigational approach. Low intracystic glucose levels have been evaluated in multiple studies for its accuracy in differentiating mucinous from nonmucinous cysts of the pancreas. METHODS Multiple databases were searched and studies that reported on the utility of intracystic glucose levels in diagnosing mucinous pancreatic cysts were analyzed. Meta-analysis was conducted using the random-effects model, heterogeneity was assessed by I2%, and pooled diagnostic test accuracy values were calculated. RESULTS Seven studies were included in the analysis from an initial total of 375 citations. The pooled sensitivity of low glucose in differentiating mucinous pancreatic cyst was 90.5% [95% confidence interval (CI): 88.1-92.5; I2=0%] and the pooled specificity was 88% (95% CI: 80.8-92.7; I2=79%). The sensitivity at a glucose cut-off of 50 was 90.1% (95% CI: 87.2-92.5; I2=0%) and the specificity was 85.3% (95% CI: 76.8-91.1; I2=76%). The sensitivity of glucose levels in pancreatic cyst fluid taken by endoscopic ultrasound guided fine-needle aspiration was 90.8% (95% CI: 87.9-93.1; I2=0%) and the specificity was 90.5% (95% CI: 81.7-95.3; I2=83%). The sensitivity of point-of-care glucometers was 89.5% (95% CI: 87.9-93.1; I2=0%) and specificity was 83.9% (95% CI: 68.5-92.6; I2=43%). CONCLUSIONS Low glucose level at a cut-off of 50 mg/dL on fluid samples collected by endoscopic ultrasound guided fine-needle aspiration and analyzed by point-of-care glucometer achieves excellent diagnostic accuracy in differentiating mucinous pancreatic cysts.
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Affiliation(s)
- Babu P Mohan
- Department of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT
| | - Deepak Madhu
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palemo, Italy
| | - Shahab R Khan
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Suresh Ponnada
- Department of Internal Medicine, Roanoke Carilion Medical Center, Roanoke, VA
| | - Saurabh Chandan
- Department of Gastroenterology, CHI Creighton University Medical Center, Omaha, NE
| | | | - Stefano F Crino
- Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona
| | - Luca Barresi
- Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palemo, Italy
| | - Stephanie McDonough
- Department of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT
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25
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Bishehsari F, Adnan D, Deshmukh A, Khan SR, Rempert T, Dhana K, Mahdavinia M. Gastrointestinal Symptoms Predict the Outcomes From COVID-19 Infection. J Clin Gastroenterol 2022; 56:e145-e148. [PMID: 33780223 PMCID: PMC8435041 DOI: 10.1097/mcg.0000000000001513] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 01/25/2021] [Indexed: 02/03/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has taken hundreds of thousands of lives globally. Besides the respiratory tract, the virus can affect the gastrointestinal (GI) tract. Data regarding the significance of GI symptoms in the COVID-19 course are limited. In this largest US study to date, the authors reviewed electronic encounters of 1003 consecutive patients who were tested positive for the virus between March 12 and April 3, 2020. Initial GI symptoms were present in up to 22.4% of patients and were associated with worse outcomes after adjustment for demographics, comorbidities, and other clinical symptoms. COVID-19 with GI involvement may define a more severe phenotype.
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Affiliation(s)
- Faraz Bishehsari
- Division of Gastroenterology, Department of Internal
Medicine, Rush University Medical Center, Chicago, IL USA
| | - Darbaz Adnan
- Division of Gastroenterology, Department of Internal
Medicine, Rush University Medical Center, Chicago, IL USA
| | - Ameya Deshmukh
- Division of Gastroenterology, Department of Internal
Medicine, Rush University Medical Center, Chicago, IL USA
| | - Shahab R. Khan
- Division of Gastroenterology, Department of Internal
Medicine, Rush University Medical Center, Chicago, IL USA
| | - Trevor Rempert
- Division of Gastroenterology, Department of Internal
Medicine, Rush University Medical Center, Chicago, IL USA
| | - Klodian Dhana
- Department of Internal Medicine, Rush University Medical
Center, Chicago, IL USA
- Rush Institute for Healthy Aging, Rush University Medical
Center, Chicago, IL USA
| | - Mahboobeh Mahdavinia
- Division of Allergy and Immunology, Department of Internal
Medicine, Rush University Medical center, Chicago, IL
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Mohan BP, Chandan S, Khan SR, Kassab LL, Ponnada S, Artifon ELA, Otoch JP, McDonough S, Adler DG. Photodynamic Therapy (PDT), Radiofrequency Ablation (RFA) With Biliary Stents in Palliative Treatment of Unresectable Extrahepatic Cholangiocarcinoma: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2022; 56:e153-e160. [PMID: 33780214 DOI: 10.1097/mcg.0000000000001524] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/29/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIM Extrahepatic unresectable cholangiocarcinoma carries a dismal prognosis. In addition to biliary drainage by stent placement; photodynamic therapy (PDT) and radiofrequency ablation (RFA) have been tried to prolong survival. In this meta-analysis, we appraise the current known data on the use of PDT, RFA in the palliative treatment of extrahepatic unresectable cholangiocarcinoma. METHODS We searched multiple databases from inception through July 2020 to identify studies that reported on PDT and RFA. Pooled rates of survival, stent patency, 30-, 90-day mortality, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95% prediction interval. RESULTS A total of 55 studies (2146 patients) were included. A total of 1149 patients underwent treatment with PDT (33 studies), 545 with RFA (22 studies), and 452 patients with stent-only strategy. The pooled survival rate with PDT, RFA, and stent-only groups was 11.9 [95% confidence interval (CI): 10.7-13.1] months, 8.1 (95% CI: 6.4-9.9) months, and 6.7 (95% CI: 4.9-8.4) months, respectively. The pooled time of stent patency with PDT, RFA, and stent-only groups was 6.1 (95% CI: 4.2-8) months, 5.5 (95% CI: 4.2-6.7) months, and 4.7 (95% CI: 2.6-6.7) months, respectively. The pooled rate of 30-day mortality with PDT was 3.3% (95% CI: 1.6%-6.7%), with RFA was 7% (95% CI: 4.1%-11.7%) and with stent-only was 4.9% (95% CI: 1.7%-13.1%). The pooled rate of 90-day mortality with PDT was 10.4% (95% CI: 5.4%-19.2%) and with RFA was 16.3% (95% CI: 8.7%-28.6%). CONCLUSION PDT seemed to demonstrate better overall survival and 30-day mortality rates than RFA and/or stent-only palliation.
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Affiliation(s)
- Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Saurabh Chandan
- Department of Gastroenterology and Hepatology, CHI-Creighton University Medical Center, Omaha, NE
| | - Shahab R Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, IL
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Suresh Ponnada
- Department of Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, VA
| | - Everson L A Artifon
- Gastrointestinal Endoscopy Unit, Hospital Das Clinicas, University of Sao Paulo, Sao Paulo, Brazil
| | - Jose P Otoch
- Gastrointestinal Endoscopy Unit, Hospital Das Clinicas, University of Sao Paulo, Sao Paulo, Brazil
| | - Stephanie McDonough
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
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Salahuddin AZ, Roy AS, Ahammed SU, Asadujjaman M, Das SK, Hossain MB, Miah OF, Borman GC, Afroz N, Bhattacharjee S, Rahman MM, Datta P, Islam MS, Hasib M, Islam H, Firoz NH, Khan SR, Saha BK, Khan SI. Pattern of Glomerular Disease in a Tertiary Care Hospital of Bangladesh. Mymensingh Med J 2022; 31:80-87. [PMID: 34999684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Glomerular disease is one of the most important causes of chronic kidney disease in developing countries like Bangladesh as well as the whole world. The pattern of glomerular disease varies in different countries and can have different clinical presentations. The aim of the study was to analyze the clinical profile and to determine the histological pattern of glomerular diseases in a large tertiary care hospital in Bangladesh. All kidney biopsies performed in Mymensingh Medical College Hospital, Bangladesh from October 2018 to March 2020 were prospectively analyzed in the study. A total of 101 patients with kidney biopsy were examined by clinical and laboratory findings and by light and immuno-fluorescence microscopy. The mean age was 30.0±14.6 years and 50(49.5%) were male and 51(50.5%) were female with a male to female ratio of 1:1. The clinical syndromes namely nephrotic syndrome, nephritic syndrome, nephrito-nephrotic presentation, RPGN like presentation, macroscopic haematuria and asymptomatic urine abnormality were present in 31.7%, 34.5%, 22.8%, 11.9%, 19.8% and 10.9% patients respectively. The most common histological varieties found in the study were mesangial proliferative glomerulonephritis (MesPGN) (18.8%) and focal segmental glomerulosclerosis (FSGS) (18.8%). Other histopathological pattern among the studied subjects revealed minimal change disease (MCD) in 5.9%, membranous nephropathy (MN) in 7.9%, membranoproliferative glomerulonephritis (MPGN) in 16.8%, IgA nephropathy in 5%, IgM nephropathy in 2%, IgG nephropathy in 2%, diffuse proliferative glomerulonephritis (DPGN) in 1%, focal proliferative glomerulo-nephritis (FPGN) in 3%, crescentic GN in 3%, lupus nephritis (LN) in 13.9%, amyloidosis in 1% and fibrillary glomerulopathy in 1% patient. The pattern of glomerular disease found in this study was similar to other studies performed in Bangladesh with a little variation. It may guide the future researchers to establish a national kidney biopsy registry in Bangladesh.
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Affiliation(s)
- A Z Salahuddin
- Dr Abu Zafor Md Salahuddin, Registrar, Department of Nephrology, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Facciorusso A, Ramai D, Gkolfakis P, Khan SR, Papanikolaou IS, Triantafyllou K, Tringali A, Chandan S, Mohan BP, Adler DG. Comparative efficacy of different methods for difficult biliary cannulation in ERCP: systematic review and network meta-analysis. Gastrointest Endosc 2022; 95:60-71.e12. [PMID: 34543649 DOI: 10.1016/j.gie.2021.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Several methods with variable efficacy have been proposed for difficult biliary cannulation in ERCP. We assessed the comparative efficacy of different strategies for difficult biliary cannulation through a network meta-analysis combining direct and indirect treatment comparisons. METHODS We identified 17 randomized controlled trials (2015 patients) that compared the efficacy of different adjunctive methods for difficult biliary cannulation (needle-knife techniques, pancreatic guidewire-assisted technique, pancreatic-assisted technique, and transpancreatic sphincterotomy) either with each other or with persistence with the standard cannulation techniques. The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) were the outcomes of interest. We performed pairwise and network meta-analysis for all treatments and used Grading of Recommendations Assessment, Development and Evaluation criteria to appraise quality of evidence. RESULTS Low-quality evidence supported the use of transpancreatic sphincterotomy over persistence with standard cannulation techniques (risk ratio [RR], 1.29; 95% confidence interval [CI], 1.05-1.59) and over any other adjunctive intervention (RR, 1.21 [95% CI, 1.01-1.44] vs pancreatic guidewire-assisted technique, RR, 1.19 [95% CI, 1.01-1.43] vs early needle-knife techniques, RR, 1.47 [95% CI, 1.03-2.10] vs pancreatic stent-assisted technique) for increasing the success rate of biliary cannulation. No other significant results were observed in any other comparisons. Based on the network model, transpancreatic sphincterotomy (P-score, .97) followed by early needle-knife techniques (P-score, .62) were ranked highest in terms of increasing the success rate of biliary cannulation. Early needle-knife techniques outperformed persistence with standard cannulation techniques in terms of decreasing PEP rate (RR, .61; 95% CI, .37-1.00), whereas both early needle-knife techniques and transpancreatic sphincterotomy led to lower PEP rates as compared with pancreatic guidewire-assisted technique (RR, .49 [95% CI, .23-.99] and .53 [95% CI, .30-.92], respectively). CONCLUSIONS Transpancreatic sphincterotomy increases the success rate of biliary cannulation as compared with persistence with the standard cannulation techniques. Early needle-knife techniques and transpancreatic sphincterotomy are superior to other interventions in decreasing PEP rates and should be considered in patients with difficult cannulation.
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Affiliation(s)
- Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Daryl Ramai
- University of Utah, Salt Lake City, Utah, USA
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Shahab R Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ioannis S Papanikolaou
- Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology, CUB Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine-Propaedeutic, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece
| | | | - Saurabh Chandan
- Gastroenterology Unit, CHI Health Creighton University Medical Center, Omaha, Nebraska, USA
| | - Babu P Mohan
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Porter Adventist Hospital/PEAK Gastroenterology, Denver, Colorado, USA
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Chandan S, Buddam A, Khan SR, Mohan BP, Ramai D, Bilal M, Dhindsa B, Bhogal N, Kassab LL, Goyal H, Perisetti A, Facciorusso A, Adler DG. Use of therapeutic anticoagulation in splanchnic vein thrombosis associated with acute pancreatitis: a systematic review and meta-analysis. Ann Gastroenterol 2021; 34:862-871. [PMID: 34815653 PMCID: PMC8596205 DOI: 10.20524/aog.2021.0661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background Splanchnic vein thrombosis is a well-recognized local vascular complication of acute pancreatitis (AP), estimated to occur in approximately 15% of patients. While splanchnic vein recanalization occurs spontaneously in approximately one third of patients, severe complications such as bowel ischemia and liver failure have also been reported. At present, there is no consensus on whether patients presenting with AP-associated splanchnic vein thrombosis should receive therapeutic anticoagulation. Methods We searched multiple databases from inception through December 2020 to collect studies that compared the clinical outcomes of patients with AP and splanchnic vein thrombosis who received therapeutic anticoagulation (AC group) with those who did not (N-AC group). A meta-analysis was performed to calculate the relative risk (RR) of vessel recanalization, bleeding complications, collateral formation and death in the 2 groups. Results Seven studies with 8353 patients, 339 of whom had splanchnic vein thrombosis, were included in the final analysis. A total of 154 patients (45.4%) had acute severe pancreatitis. A significantly higher proportion of patients had vessel recanalization in the AC group: RR 1.6, 95% confidence interval 1.17-2.27; I2=0%; P=0.004. There was no difference between the 2 groups in the RR of bleeding complications, collateral formation and death. Conclusions Our analysis demonstrated that, among patients with AP-associated splanchnic vein thrombosis, therapeutic anticoagulation resulted in recanalization of the involved vessels without significantly increasing the risk of bleeding complications. There was no difference in the RR of death or the rates of collateral vessel formation during the follow up.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA (Saurabh Chandan, Avanija Buddam)
| | - Avanija Buddam
- Division of Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA (Saurabh Chandan, Avanija Buddam)
| | - Shahab R Khan
- Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA (Shahab R. Khan)
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA (Babu P. Mohan, Douglas G. Adler)
| | - Daryl Ramai
- Internal Medicine, Brooklyn Hospital Center, Brooklyn, New York, USA (Daryl Ramai)
| | - Mohammad Bilal
- Division of Gastroenterology, University of Minnesota & Minneapolis VA Health Care System, Minneapolis, Minnesota, USA (Mohammad Bilal)
| | - Banreet Dhindsa
- Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA (Banreet Dhindsa, Neil Bhogal)
| | - Neil Bhogal
- Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA (Banreet Dhindsa, Neil Bhogal)
| | - Lena L Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA (Lena L. Kassab)
| | - Hemant Goyal
- Gastroenterology, The Wright Center For Graduate Medical Education, Scranton, Philadelphia, USA (Hemant Goyal)
| | - Abhilash Perisetti
- Gastroenterology & Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA (Abhilash Perisetti)
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy (Antonio Facciorusso)
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA (Babu P. Mohan, Douglas G. Adler)
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Ramai D, Singh J, Mohan BP, Madedor O, Brooks OW, Barakat M, Ofosu A, Khan SR, Chandan S, Dhindsa B, Dhaliwal A, Facciorusso A, McDonough S, Adler DG. Influence of the Elipse Intragastric Balloon on Obesity and Metabolic Profile: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2021; 55:836-841. [PMID: 33394629 DOI: 10.1097/mcg.0000000000001484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intragastric balloons (IGBs) have been used to bridge the obesity treatment gap with the benefits of being minimally invasive but still required endoscopy. The Elipse IGB is a swallowable balloon that is spontaneously excreted at ∼16 weeks. However, studies are limited by small sample sizes. The authors aim to assess clinically relevant endpoints, namely weight loss outcomes, metabolic profile, balloon tolerability, and adverse events. METHODS A literature search was performed from several databases from inception to July 2020. The pooled means and proportions of our data were analyzed using a random effects model. RESULTS Seven studies involving 2152 patients met our eligibility criteria and were included. The mean baseline body mass index ranged from 32.1 to 38.6. The pooled mean difference (MD) in body mass index was 0.88 [confidence interval (CI): 0.58-1.18, I2=98%]. Total body weight loss was 12% (CI: 10.1-14.3, I2=94%) and excess body weight loss was 49.1% (CI: 30.6-67.5, I2=97%). The MD in waist circumference was 0.89 (CI: 0.72-1.05, I2=53%). MD in triglyceride level was 0.66 (CI: 0.21-1.1, I2=96%). Pooled early deflation rate was 1.8% (CI: 0.6-5.1, I2=74%). Our study also showed that the Elipse balloon was associated with less adverse events when compared with other IGBs. CONCLUSIONS This meta-analysis demonstrates that the Elipse intragastric balloon is a safe, effective, and tolerable device for weight loss and obesity with a minimal side effect profile.
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Affiliation(s)
| | - Jameel Singh
- Department of Internal Medicine, Mathers Hospital, Port Jefferson, NY
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Ogenetega Madedor
- Department of Medicine, Spectrum Health Hospital/Michigan State University, Grand Rapids, MI
| | - Olivia W Brooks
- Department of Internal Medicine
- St. George's University School of Medicine, Grenada, WI
| | - Mohamed Barakat
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn
| | - Andrew Ofosu
- Division of Gastroenterology, Stanford University, Stanford, CA
| | - Shahab R Khan
- Division of Gastroenterology, Rush University Medical Center, Chicago, II
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Health Creighton University Medical Center
| | - Banreet Dhindsa
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE
| | - Amaninder Dhaliwal
- Division of Gastroenterology, Moffitt Cancer Center, University of South Florida, Tampa, FL
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Stephanie McDonough
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
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Kochhar GS, Mohan BP, Khan SR, Chandan S, Kassab LL, Ponnada S, Desai A, Caldera F, Dulai PS, Farraye FA. Hepatitis-B Vaccine Response in Inflammatory Bowel Disease Patients: A Systematic Review and Meta-analysis. Inflamm Bowel Dis 2021; 27:1610-1619. [PMID: 33393585 DOI: 10.1093/ibd/izaa353] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Data on efficacy of hepatitis-B vaccine (HBV) in patients with inflammatory bowel disease (IBD) is limited. Our aim was to review the literature and perform meta-analysis of available studies to quantify efficacy of HBV in patients with IBD. METHODS We conducted a comprehensive search of several databases (inception to July 2020) to identify studies evaluating efficacy of HBV in patients with IBD. Random effects model was used to calculate the pooled rates and I2 percentage values were used to assess the heterogeneity. RESULTS A total of 14 studies (2375 patients) were included. Four data sets were available from 2 studies that compared HBV response in patients with IBD against healthy controls. The pooled odds ratio of HBV response in IBD patients was 0.13 (95% CI, 0.05-0.33, P = 0.001). The pooled proportion of adequate immune response (AIR) was 64% (95% CI, 55-72.1, P = 0.003) from 13 data sets, and effective immune response (EIR) was 39.7% (95% CI, 30.7-49.5, P = 0.04) from 10 data sets. CONCLUSION Patients with IBD on immunosuppression demonstrated significantly reduced HBV response as compared with general population.
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Affiliation(s)
- Gursimran S Kochhar
- Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Babu P Mohan
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Shahab R Khan
- Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Saurabh Chandan
- Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, Nebraska, USA
| | - Lena L Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA
| | - Aakash Desai
- Gastroenterology, Hepatology & Nutrition, Metro Health Hospital, Cleveland, Ohio, USA
| | - Freddy Caldera
- Gastroenterology & Hepatology, University of Wisconsin School of Medicine & Public Health Madison, Wisconsin, USA
| | - Parambir S Dulai
- Gastroenterology, Hepatology & Nutrition, University of California, San Diego, California, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Cader FA, Chowdhury IZ, Haq MM, Chowdhury MZ, Khan SR. Impact of the COVID-19 pandemic on cardiology services at a tertiary cardiac centre in a low- and middle-income country in Asia. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic resulted in reduced numbers of patients presenting with and undergoing procedures for cardiac conditions worldwide. This impact, specifically looking at the changes in patient visits, admissions and procedure volumes, has not been recorded thus far, in terms of a South Asian LMIC setting.
Purpose
We aimed to assess the impact of the pandemic on emergency room (ER) visits, cardiology admissions, out-patient and in-patient procedures at a LMIC tertiary cardiac centre.
Methods
Data on ER visits, specific in-patient and out-patient procedures (echocardiography, exercise stress tests, electrocardiography [ECG]) were collected via hospital electronic records from January to December 2020, and compared with corresponding data for the same months in 2019. The difference or deficits were expressed as a percentage (%Δ). Data for each quarter were compared using paired t-test. A p value <0.05 was considered significant.
Results
There were significantly reduced numbers of out-patient visits (Δ −31.2%; p=0.007), ER visits (%Δ −59.5%; p=0.0), in-patient admissions (Δ −33.1%; p=0.005), total out-patient procedures (%Δ −31.9%; p=0.008) and catheterization volumes (%Δ-29.7%; p=0.001) in 2020, as compared with 2019 (Table 1 & Figure 1). Among out-patient procedures, adult trans-thoracic echo, ECG and stress tests showed greatest deficits in April 2020. No trans-oesophageal echocardiograms were performed in April to July 2020. The greatest deficits were observed in April 2020, as compared with 2019 (out-patient visits: Δ-92.7%; out-patient procedures: %Δ-94.5%; in-patient admissions: %Δ-85.9%; catheterization procedures: %Δ-85.2%), except for ER visits, where the greatest deficit was seen in June 2020: %Δ-90.7%). Numbers continued to remain extremely low in May 2020, coinciding with the nation-wide lockdown measures. Out-patient visits, procedures and in-patient admissions have gradually increased since July 2020. However, the greatest impact seems to have been on ER visits, continued to remain low, with significantly reduced volumes in both 2nd and 3rd quarters of 2020. The lowest deficits in outpatient visits (Δ-4.9%), ER visits (Δ-31.9%) and out-patient procedures (Δ-0.9%) were seen in December 2020, while for in-patient admissions (Δ-7.9%) and catheterization procedures (Δ-6.5%) this was in October 2020.
Conclusion
There was a significant reduction of out-patient and in-patient cardiology services volumes in 2020, with the greatest reduction in April and May, coinciding with a general “lockdown”. ER visits were the most greatly affected. Trends show a steady increase in out-patient and catheterization procedures, beginning from July, but have not yet reached pre-COVID volumes, even by the end of 2020. These findings indicate that, the pandemic has resulted in significantly fewer ER visits; however, patients still present as outpatients, both for procedures and catheterization.
Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
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Affiliation(s)
- F A Cader
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | - I Z Chowdhury
- BIRDEM General Hospital, Medicine, Dhaka, Bangladesh
| | - M M Haq
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | - M Z Chowdhury
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | - S R Khan
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
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Cader FA, Chowdhury IZ, Chowdhury MZ, Haq MM, Khan SR. Impact of the COVID-19 pandemic on catheterization laboratory procedural volumes at a tertiary cardiac centre in a low- & middle-income country in South Asia. Eur Heart J 2021. [PMCID: PMC8767573 DOI: 10.1093/eurheartj/ehab724.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Globally, reports have suggested that cardiac catheterization procedures, particularly elective coronary procedures declined as a result of the COVID-19 pandemic. However, there is scarce data on this aspect, in terms of a South Asian low- & middle-income country (LMIC) setting. Purpose We aimed to evaluate temporal trends and impact of the pandemic on elective and emergency cardiac catheterization procedural volumes at a high-volume tertiary cardiac centre in a LMIC. Methods Data on both emergency and elective catheterization procedures, including coronary angiography, percutaneous coronary intervention (PCI), peripheral angiography, pacing & electrophysiology (EP) were collected from January to December 2020, and compared with corresponding data for the same months in 2019. Data were obtained from hospital's catheterization laboratory database. The difference was expressed as a percentage (%Δ). Data for each quarter were compared using paired t-test. A p value <0.05 was considered significant. Results Overall, a significant (32.4%) reduction of cath lab procedures was seen in 2020, as compared with 2019 (p=0.006). There were significantly reduced numbers of coronary angiographies (%Δ −31.4%; p=0.009), PCI (%Δ −32.2%; p=0.008), peripheral procedures (%Δ −69.9%; p=0.001) and pacing & EP procedures (Δ−-48.7%; p=0.001) in 2020, as compared with 2019 (Table 1 & Figure 1). For coronary procedures this was most marked in 2nd and 3rd quarters of 2020 (p<0.05). The greatest deficits for coronary angiographies were observed in April 2020, compared to 2019 (Δ −85.1%); the greatest reductions in PCI (Δ-87.7%) and pacing & EP (Δ −94.7%) were seen in May 2020, coinciding with the nation-wide lockdown measures. Coronary procedures showed a gradually increasing trend since July 2020. Given their elective nature, no peripheral procedures were performed from April to July 2020. In terms of PCI, there was a significant reduction in elective procedures in the 2nd quarter of 2020 (p=0.001), with a steep “catch-up” incline in September (Δ +2.9%) and October 2020 (Δ −8.3%), coinciding with availability of in-hospital COVID19 screening tests (Table 1). Among ad hoc PCI for acute coronary syndrome (ACS), although a 32.3% reduction was seen overall (p=0.108), a significant decrease was only observed in the 2nd quarter. Ad hoc PCI for non-ACS was significantly reduced throughout 2nd to 4th quarters of 2020. In line with national guidelines preferring fibrinolysis as first-line for STEMI, as well as absence of negative pressure ventilation cath labs and unavailability of rapid-screening COVID test kits, no primary PCI procedures were performed since May 2020. Conclusion The impact of COVID-19 resulted in a significant reduction in all cardiac catheterization procedures in 2020, as compared with 2019. This reduction was most marked for coronary procedures in the 2nd and 3rd quarters of 2020, with a significant reduction in elective procedures. Funding Acknowledgement Type of funding sources: None.
Table 1 ![]()
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Affiliation(s)
- F A Cader
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | - I Z Chowdhury
- BIRDEM General Hospital, Medicine, Dhaka, Bangladesh
| | - M Z Chowdhury
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | - M M Haq
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
| | - S R Khan
- Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh
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Ramai D, Singh J, Brooks OW, Barakat M, Mohan BP, Chandan S, Khan SR, Dhindsa B, Dhaliwal A, Ofosu A, Adler DG. Comparison of left versus right lateral starting position on colonoscopy: a systematic review and meta-analysis of randomized controlled trials. Ann Gastroenterol 2021; 34:699-704. [PMID: 34475741 PMCID: PMC8375655 DOI: 10.20524/aog.2021.0639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background Modifying patient position during colonoscopy has been proposed as a simple and inexpensive technique to increase luminal distention and improve navigation through the large bowel. The left lateral (LL) decubitus starting position is commonly used during colonoscopy. However, reports indicate that other starting positions may offer additional benefit. We aimed to determine if the right lateral (RL) starting position compared to the standard LL starting position could improve outcomes in colonoscopy. Methods We searched PubMed, Medline, and EMBASE through June 2020 to identify studies comparing RL and LL starting positions during colonoscopy. The primary outcomes included mean cecal insertion time and cecal intubation rate, and adverse events were assessed by pooling data using a random-effects model expressed in terms of odds ratio (OR), mean difference, and 95% confidence interval (CI). Results We identified 5 randomized controlled trials, including 809 participants, that compared LL vs. RL colonoscopy. The pooled OR for cecal intubation rate was 1.3 (95%CI 0.8-2.3; P=0.3). The mean difference in mean cecal insertion time was 0.08 (95%CI -0.09 to 0.26; P=0.4). Heterogeneity between studies was low (I 2=0%). No complications were reported in either arm of the study. Pain scores assessed using a visual analog scale were comparable among both arms of the study. Conclusion The RL starting position for colonoscopy was comparable to the LL and offered no additional benefit in terms of cecal intubation time, intubation rate, or patient discomfort.
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Affiliation(s)
- Daryl Ramai
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York (Daryl Ramai, Olivia W. Brooks)
| | - Jameel Singh
- Department of Internal Medicine, Mather Hospital, Port Jefferson, New York (Jameel Singh)
| | - Olivia W Brooks
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York (Daryl Ramai, Olivia W. Brooks)
| | - Mohamed Barakat
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York (Mohamed Barakat)
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah (Babu P. Mohan, Douglas G. Adler)
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, Nebraska (Saurabh Chandan)
| | - Shahab R Khan
- Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois (Shahab R. Khan)
| | - Banreet Dhindsa
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Banreet Dhindsa)
| | - Amaninder Dhaliwal
- Division of Gastroenterology, Moffitt Cancer Center, University of South Florida, Tampa, Florida (Amaninder Dhaliwal)
| | - Andrew Ofosu
- Division of Gastroenterology, Stanford University, Stanford, California (Andrew Ofosu), USA
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah (Babu P. Mohan, Douglas G. Adler)
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Chandan S, Khan SR, Kumar A, Mohan BP, Ramai D, Kassab LL, Draganov PV, Othman MO, Kochhar GS. Efficacy and histologic accuracy of underwater versus conventional endoscopic mucosal resection for large (>20 mm) colorectal polyps: a comparative review and meta-analysis. Gastrointest Endosc 2021; 94:471-482.e9. [PMID: 33385463 DOI: 10.1016/j.gie.2020.12.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/18/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Major limitations with conventional EMR (C-EMR) include high rates of polyp recurrence and low en-bloc resection rates, especially for lesions >20 mm in size. Underwater EMR (U-EMR) has emerged as an alternate technique for en-bloc resection of larger lesions. We conducted a systematic review and meta-analysis comparing the efficacy and safety of the 2 techniques. METHODS Multiple databases were searched through June 2020 for studies that compared outcomes of U-EMR and C-EMR for colorectal lesions. Meta-analysis was performed to determine pooled odds ratios (ORs) of successful R0, en-bloc, and piecemeal resection of colorectal lesions. We compared the rates of polyp recurrence at follow-up, diagnostic accuracy for colorectal cancer, and adverse events with the 2 techniques. RESULTS Eleven studies, including 4 randomized controlled trials (RCTs) with 1851 patients were included in the final analysis. A total of 1071 lesions were removed using U-EMR, and 1049 lesions were removed using C-EMR. Although U-EMR had an overall superior en-bloc resection rate compared with C-EMR (OR, 1.9; 95% confidence interval [CI], 1-3.5; P = .04), both techniques were comparable in terms of polyps >20 mm in size (OR, 0.8; 95% CI, 0.3-2.1; P = .75), R0 resection (OR, 3.1; 95% CI, 0.74-12.6; P = .14), piecemeal resection (OR, 3.1; 95% CI, 0.74-12.6; P = .13), and diagnostic accuracy for colorectal cancer (OR, 1.1; 95% CI, 0.6-1.8; P = .82). There were lower rates of polyp recurrence (OR, 0.3; 95% CI, 0.1-0.8; P = .01) and incomplete resection (OR, 0.4; 95% CI, 0.2-0.5; P = .001) with U-EMR. Both techniques have comparable resection times and safety profiles. CONCLUSIONS Our results support the use of U-EMR over C-EMR for successful resection of colorectal lesions. Further randomized controlled trials are needed to evaluate the efficacy of U-EMR for resecting polyps >20 mm in size.
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Affiliation(s)
- Saurabh Chandan
- Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, USA
| | - Shahab R Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Anand Kumar
- Gastroenterology & Hepatology, Lenox Hill Hospital, New York, New York, USA
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Daryl Ramai
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, New York, USA
| | - Lena L Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter V Draganov
- Gastroenterology, University of Florida Health, Gainesville, Florida, USA
| | - Mohamed O Othman
- Division of Gastroenterology, Baylor College of Medicine, Houston, Texas, USA
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Chandan S, Facciorusso A, Khan SR, Ramai D, Mohan BP, Bilal M, Dhindsa B, Kassab LL, Goyal H, Perisetti A, Bhat I, Singh S, McDonough S, Adler DG. Short versus standard esophageal myotomy in achalasia patients: a systematic review and meta-analysis of comparative studies. Endosc Int Open 2021; 9:E1246-E1254. [PMID: 34447872 PMCID: PMC8383091 DOI: 10.1055/a-1490-8493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Despite the clinical efficacy of peroral endoscopic myotomy (POEM), postoperative symptomatic gastroesophageal reflux disease (GERD) remains a major concern. While it is known that length of the gastric myotomy affects postoperative GERD, the clinical relevance of variation in esophageal myotomy length is not well known. We performed a systematic review and meta-analysis of studies comparing outcomes of short versus standard myotomy length in patients with achalasia. Patients and methods We searched multiple databases from inception through November 2020 to identify studies that reported on outcomes of achalasia patients who underwent short compared with standard esophageal myotomy. Meta-analysis was performed to determine pooled odds ratio (OR) of clinical success, GERD outcomes, and adverse events with the two techniques. Results 5 studies with 474 patients were included in the final analysis (short myotomy group 214, standard myotomy group 260). There was no difference in clinical success (OR 1.17, 95 % confidence interval [CI] 0.54-2.52; I2 0 %; P = 0.69), postoperative symptomatic GERD (OR 0.87, 95 %CI 0.44-1.74; I2 29 %; P = 0.70), and overall adverse events (OR 0.52, 95 %CI 0.19-1.38; I2 40 %; P = 0.19), between the two groups. Incidence of postoperative erosive esophagitis as determined by endoscopy was lower in the short myotomy group (OR 0.50, 95 %CI 0.24-1.03; I2 0 %; P = 0.06). Conclusion Our analysis showed that performing POEM with short esophageal myotomy in achalasia was as safe and effective as standard myotomy, with lower incidence of postoperative erosive esophagitis.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Shahab R. Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
| | - Daryl Ramai
- Internal Medicine, Brooklyn Hospital Center, Brooklyn, New York, United States
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Mohammad Bilal
- Division of Gastroenterology, University of Minnesota and Minneapolis VA Health Care System, Minneapolis, Minnesota, United States
| | - Banreet Dhindsa
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Hemant Goyal
- Gastroenterology, Wright Center for Graduate Medical Education, Scranton, Philadelphia, United States
| | - Abhilash Perisetti
- Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Ishfaq Bhat
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Shailender Singh
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Stephanie McDonough
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Ramai D, Singh J, Kani T, Barakat M, Chandan S, Brooks OW, Ofosu A, Khan SR, Dhindsa B, Dhaliwal A, Quintero EJ, Cheung D, Facciorusso A, McDonough S, Adler DG. Wet- versus dry-suction techniques for EUS-FNA of solid lesions: A systematic review and meta-analysis. Endosc Ultrasound 2021; 10:319-324. [PMID: 34259217 PMCID: PMC8544017 DOI: 10.4103/eus-d-20-00198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The optimal sampling techniques for EUS-FNA remain unclear and have not been standardized. To improve diagnostic accuracy, suction techniques for EUS-FNA have been developed and are widely used among endoscopists. The aim of this study was to compare wet-suction and dry-suction EUS-FNA techniques for sampling solid lesions. We performed a comprehensive literature search of major databases (from inception to June 2020) to identify prospective studies comparing wet-suction EUS-FNA and dry-suction EUS-FNA. Specimen adequacy, sample contamination, and histologic accuracy were assessed by pooling data using a random-effects model expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Six studies including a total of 418 patients (365 wet suction vs. 377 dry suction) were included in our final analysis. The study included a total of 535 lesions (332 pancreatic lesions and 203 nonpancreatic lesions). The pooled odds of sample adequacy was 3.18 (CI: 1.82-5.54, P = 0.001) comparing wet- and dry-suction cohorts. The pooled odds of blood contamination was 1.18 (CI: 0.75-1.86, P = 0.1). The pooled rate for blood contamination was 58.33% (CI: 53.65%-62.90%) in the wet-suction cohort and 54.60% (CI 49.90%- 59.24%) in the dry-suction cohort (P = 0.256). The pooled odds of histological diagnosis was 3.68 (CI 0.82-16.42, P = 0.1). Very few adverse events were observed and did not have an impact on patient outcomes using either method. EUS-FNA using the wet-suction technique offers higher specimen quality through comparable rates of blood contamination and histological accuracy compared to dry-suction EUS-FNA.
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Affiliation(s)
- Daryl Ramai
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Jameel Singh
- Department of Internal Medicine, Mather Hospital, Port Jefferson, New York, USA
| | - Tarik Kani
- Langone Health, Inflammatory Bowel Disease Center, New York University, New York, USA; Department of Gastroenterology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Mohamed Barakat
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Health Creighton University Medical Center, Omaha, Nebraska, USA
| | - Olivia W Brooks
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Andrew Ofosu
- Division of Gastroenterology, Stanford University, Stanford, California, USA
| | - Shahab R Khan
- Division of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Banreet Dhindsa
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Amaninder Dhaliwal
- Division of Gastroenterology, Moffitt Cancer Center, University of South Florida, Tampa, Florida, USA
| | - Eduardo J Quintero
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Derrick Cheung
- Division of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Antonio Facciorusso
- Department of Medical Sciences, Section of Gastroenterology, University of Foggia, 71122 Foggia, Italy
| | - Stephanie McDonough
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Hospital, Peak Gastroenterology, Denver, Colorado, USA
| | - Douglas G Adler
- Center for Advanced Therapeutic Endoscopy (CATE), Centura Health, Porter Hospital, Peak Gastroenterology, Denver, Colorado, USA
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Chandan S, Arora S, Mohan BP, Khan SR, Chandan OC, Kassab LL, Murali AR. Multimedia based education on bowel preparation improves adenoma detection rate: Systematic review & meta-analysis of randomized controlled trials. Dig Endosc 2021; 33:730-740. [PMID: 32794240 DOI: 10.1111/den.13809] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colorectal cancer (CRC) is the third most common cause of cancer worldwide. Studies have shown a strong association between screening colonoscopy and a reduced risk of death from colorectal cancers. The incidence of poor bowel preparation has been reported in up to 25% cases. We conducted a systematic review and comprehensive meta-analysis to evaluate the effect of patient education using multimedia platforms on adenoma detection rate and adequacy of bowel preparation. METHODS Multiple databases were searched through May 2020 for studies that reported the efficacy of multimedia education (smartphone app and online audio-visual aids) in improving quality of bowel preparation and its effect on adenoma detection rate (ADR). Meta-analysis was performed to determine whether multimedia based patient education (MM) helps improve ADR and bowel preparation quality as compared to controls (CT). RESULTS We included 13 randomized controlled trials with a total of 3754 patients. Eight studies reported outcomes on ADR and 12 reported on adequacy of bowel preparation. Overall ADR was higher in patients receiving multimedia based education as compared to CT (risk ratio (RR) 1.25, confidence interval (CI) 1.01-1.56, P = 0.04). A higher proportion of patients receiving multimedia based education achieved adequate bowel preparation (RR 1.2, CI 1.1-1.3, P = 0.001). In patients with mean age over 50 years, ADR was better in MM cohort as compared to controls (RR 1.3, CI 1.1-1.6, P = 0.001). CONCLUSION Pre-colonoscopy patient education using multimedia based platforms seems to improve ADR and the adequacy of bowel preparation.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, USA
| | - Sumant Arora
- Gastroenterology & Hepatology, University of Iowa, Iowa City, USA
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, USA
| | - Shahab R Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, USA
| | - Ojasvini C Chandan
- Department of Pediatric Gastroenterology, Hepatology & Nutrition, University of Nebraska Medical Center, Omaha, USA
| | | | - Arvind R Murali
- Gastroenterology & Hepatology, University of Iowa, Iowa City, USA
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Ofosu A, Mohan BP, Ichkhanian Y, Masadeh M, Febin J, Barakat M, Ramai D, Chandan S, Haiyeva G, Khan SR, Aghaie Meybodi M, Facciorusso A, Repici A, Wani S, Thosani N, Khashab MA. Peroral endoscopic myotomy (POEM) vs pneumatic dilation (PD) in treatment of achalasia: A meta-analysis of studies with ≥ 12-month follow-up. Endosc Int Open 2021; 9:E1097-E1107. [PMID: 34222636 PMCID: PMC8216779 DOI: 10.1055/a-1483-9406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Peroral endoscopic myotomy (POEM) is increasingly being used as the preferred treatment option for achalasia. The aim of this systematic review and meta-analysis was to compare the efficacy and safety of POEM versus pneumatic balloon dilation (PD). Methods We performed a comprehensive review of studies that reported clinical outcomes of POEM and PD for the treatment of achalasia. Measured outcomes included clinical success (improvement of symptoms based on a validated scale including an Eckardt score ≤ 3), adverse events, and post-treatment gastroesophageal reflux disease (GERD). Results Sixty-six studies (6268 patients) were included in the final analysis, of which 29 studies (2919 patients) reported on POEM and 33 studies (3050 patients) reported on PD and 4 studies (299 patients) compared POEM versus PD. Clinical success with POEM was superior to PD at 12, 24, and 36 months (92.9 %, vs 76.9 % P = 0.001; 90.6 % vs 74.8 %, P = 0.004; 88.4 % vs 72.2 %, P = 0.006, respectively). POEM was superior to PD in type I, II and III achalasia (92.7 % vs 61 %, P = 0.01; 92.3 % vs 80.3 %, P = 0.01; 92.3 %v 41.9 %, P = 0.01 respectively) Pooled OR of clinical success at 12 and 24 months were significantly higher with POEM (8.97; P = 0.001 & 5.64; P = 0.006). Pooled OR of GERD was significantly higher with POEM (by symptoms: 2.95, P = 0.02 and by endoscopic findings: 6.98, P = 0.001). Rates of esophageal perforation (0.3 % vs 0.6 %, P = 0.8) and significant bleeding (0.4 % vs 0.7 %, P = 0.56) were comparable between POEM and PD groups. Conclusions POEM is more efficacious than PD in the treatment of patients with achalasia during short-term and long-term follow-up, albeit with higher risk of abnormal esophageal acid exposure.
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Affiliation(s)
- Andrew Ofosu
- Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
| | - Babu P. Mohan
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, United States
| | - Yervant Ichkhanian
- Internal Medicine, Henry Ford University Medical Center, Detroit, Michigan, United States
| | - Maen Masadeh
- Kaiser Permanente Northern California, California, United States
| | - John Febin
- Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
| | - Mohamed Barakat
- Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
| | - Daryl Ramai
- Gastroenterology and Hepatology, Stanford University, Stanford, California, United States
| | - Saurabh Chandan
- Gastroenterology and Hepatology, University of Nebraska, United States
| | - Gulara Haiyeva
- Beneficts Hospital Inc., Great Falls, Montana, United States
| | - Shahab R. Khan
- Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
| | - Mohamad Aghaie Meybodi
- Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore, Maryland, United States
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Alessandro Repici
- Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Sachin Wani
- Gastroenterology, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Nirav Thosani
- Gastroenterology, Hepatology and Nutrition, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Mouen A. Khashab
- Gastroenterology and Hepatology, John Hopkins University Hospital, Baltimore, Maryland, United States
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Singh JK, Ramai D, Tartaglia N, Ambrosi A, Khan SR, Chandan S, Facciorusso A. Utilization of hepatocellular carcinoma surveillance programs in patients with cirrhosis: A systematic review and meta-analaysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16141 Background: Patients with cirrhosis are advised to undergo hepatocellular carcinoma (HCC) surveillance every six months. Routine screening is associated with early tumor detection and improved survival. However, surveillance is underutilized. We aimed to characterize the impact of HCC surveillance interventions on patient uptake and concomitant detection of HCC. Methods: We performed a comprehensive literature search of major databases (from inception to October 2020) to identify studies which assess the impact of HCC surveillance programs in patients with cirrhosis. Our primary endpoint was uptake of screening defined as having an abdominal sonogram every at least every 6 months. Secondary endpoint was the detection of HCC following screening. Pooled data was assessed using a random-effects model expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Results: Nine studies were included for meta-analysis which involved 5,021 patients with cirrhosis. Patients with a history of hepatitis B or C accounted for 40.5% of the study cohort. Comparing both screening and control groups, patients were 5 times more likely to undergo abdominal sonography if they participated in surveillance programs versus usual care (OR 4.69; CI: 2.41 – 9.13, I2: 94%). Overall, the mean difference in patients who did undergo screening versus those who did not participate in surveillance was 30.6% (CI: 19.2% – 41.9%, P < 0.001). Comparing both screening and control groups, patients were 1.5 times more likely to be diagnosed with HCC if they participated in surveillance programs (OR 1.49; CI: 0.57 – 3.89, I2: 65%). On subgroup analysis, comparing type of intervention program, dedicated surveillance programs showed a higher uptake compared to clinical reminders, though not statistically significant (dedicated programs OR 62.6, CI: 1.53 – 2559.5 vs clinical reminders OR 2.63, CI: 1.82 – 3.79). Conclusions: Patient uptake in HCC surveillance remains underutilized. Interventions such as dedicated surveillance programs and clinical reminders systems can significantly increase uptake of abdominal sonography and cancer detection.
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Affiliation(s)
| | | | | | | | - Shahab R. Khan
- Brigham and Women's Hospital, Harvard Medical School, Department of Medicine, Boston, MA
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Ramai D, Singh J, Lester J, Khan SR, Chandan S, Tartaglia N, Ambrosi A, Serviddio G, Facciorusso A. Systematic review with meta-analysis: bariatric surgery reduces the incidence of hepatocellular carcinoma. Aliment Pharmacol Ther 2021; 53:977-984. [PMID: 33721336 DOI: 10.1111/apt.16335] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/21/2021] [Accepted: 03/01/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Obesity is a risk factor for non-alcoholic steatohepatitis (NASH) and increases the risk of several cancer types including cancers of the liver. Bariatric surgery can provide durable weight loss, but little is known about the later development of hepatocellular carcinoma (HCC) after surgery. AIM To determine whether bariatric surgery reduces the risk of HCC. METHODS We performed a comprehensive literature search of major databases (from inception to November 2020) to identify studies which assess the incidence and risk of HCC following bariatric surgery. Pooled data were assessed using a random-effects model expressed in terms of odds ratio (OR), incidence rate ratio and 95% confidence interval (CI). RESULTS Nine studies (two abstracts and seven full texts) were included for meta-analysis which involved 19 514 750 patients (18 423 546 controls and 1 091 204 bariatric patients). Pooled unadjusted odds ratio (OR) was 0.40 (95% CI: 0.28-0.57) which favoured bariatric surgery, though with high heterogeneity (I2 : 79%). Using an adjusted model derived from matched cohorts (five studies) yielded an OR of 0.63 (95% CI: 0.53-0.75) with moderate heterogeneity (I2 : 38%). The pooled rate/1000 person-years was 0.05 (95% CI: 0.02-0.07) in bariatric surgery patients and 0.34 (95% CI: 0.20-0.49) in the control group with an incidence rate ratio of 0.28 (95% CI: 0.18-0.42). CONCLUSION Bariatric surgery is associated with a decreased risk of HCC.
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Affiliation(s)
- Daryl Ramai
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Jameel Singh
- Department of Internal Medicine, Mather Hospital, Northwell Health, Port Jefferson, NY, USA
| | - Janice Lester
- Health Science Library, Long Island Jewish Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Shahab R Khan
- Division of Gastroenterology, Rush University Medical Center, Chicago, IL, USA
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Health Creighton University Medical Center, Omaha, NE, USA
| | - Nicola Tartaglia
- General Surgery Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Ambrosi
- General Surgery Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Gaetano Serviddio
- Hepatology Unit, Centro C.U.R.E., Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Facciorusso
- Section of Gastroenterology, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy
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Chandan S, Mohan BP, Khan SR, Jha LK, Dhaliwal AJ, Bilal M, Aziz M, Canakis A, Arora S, Malik S, Kassab LL, Ponnada S, Bhat I, Hewlett AT, Sharma N, McDonough S, Adler DG. Clinical efficacy and safety of magnetic sphincter augmentation (MSA) and transoral incisionless fundoplication (TIF2) in refractory gastroesophageal reflux disease (GERD): a systematic review and meta-analysis. Endosc Int Open 2021; 9:E583-E598. [PMID: 33869732 PMCID: PMC8043814 DOI: 10.1055/a-1352-2944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 12/09/2020] [Indexed: 10/27/2022] Open
Abstract
Abstract
Background and study aims Proton pump inhibitors (PPI) are effective medical therapy options for gastro-esophageal reflux disease (GERD). However, 20 % to 40 % of patients report symptoms despite taking daily PPI. Transoral incisionless fundoplication (TIF2) and magnetic sphincter augmentation (MSA) are less invasive options for the treatment of refractory GERD and are increasingly gaining popularity.
Methods We conducted a comprehensive search of several databases to identify relevant studies. Our primary aim was to compare the efficacy of both interventions reported as improvement in Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) score, overall patient satisfaction, improvement in post-procedure regurgitation, and fraction of patients completely off PPI therapy at follow up.
Results Twenty-four studies with 1942 patients were included in the final analysis. Both MSA and TIF2 had comparable technical success and clinical success based on improvement in GERD-HRQL scores i. e. 98.8 % (CI 95.6,99.7) vs 98.5 % (CI 95.7,99.5) and 80.4 % (CI 66,89.6) vs 77.7 % (CI 64.1,87.2), respectively. A significantly greater proportion of patients reported improvement in regurgitation, i. e. 91.1 % (CI 83.8,95.3) vs 73.1 % (CI 62.5,81.7) and were able to completely discontinue PPI therapy with MSA compared to TIF2 i. e. 91.3 % (CI 81.5,96.2) vs 63.8 % (CI 51.6,74.4). Patients’ BMI and presence of a hiatal hernia did not have any effect on procedural outcomes.
Conclusion Both procedures performed at par when comparing clinical success in terms of improvement in GERD-HRQL scores. In terms of overall patient satisfaction, post procedure regurgitation and cumulative number of patients off PPI therapy, MSA outperforms TIF2.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Shahab R. Khan
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Lokesh K. Jha
- Gastroenterology, Parkview Health, Fort Wayne, Indianapolis, United States
| | - Amaninder J. Dhaliwal
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Mohammad Bilal
- Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Muhammad Aziz
- Internal Medicine, University of Toledo, Toledo, Ohio, United States
| | - Andrew Canakis
- Internal Medicine, Boston University Medical Center, Boston, Massachusetts, United States
| | - Sumant Arora
- Gastroenterology & Hepatology, University of Iowa, Iowa City, Iowa, United States
| | - Sarah Malik
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States
| | - Ishfaq Bhat
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Alexander T. Hewlett
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Neil Sharma
- Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - Stephanie McDonough
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Chandan S, Khan SR, Mohan BP, Shah AR, Bilal M, Ramai D, Bhogal N, Dhindsa B, Kassab LL, Singh S, Ponnada S, Nguyen AK, McDonough S, Adler DG. EUS-guided gastroenterostomy versus enteral stenting for gastric outlet obstruction: Systematic review and meta-analysis. Endosc Int Open 2021; 9:E496-E504. [PMID: 33655056 PMCID: PMC7899789 DOI: 10.1055/a-1341-0788] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Endoscopic and surgical techniques have been utilized for palliation of gastric outlet obstruction (GOO). Enteral stenting (ES) is an established technique with high clinical success and low morbidity rate. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is a novel approach that aims to provide sustained palliation of GOO. We conducted a comprehensive review and meta-analysis to evaluate the effectiveness in terms of clinical and technical success, as well as the safety profile of EUS-GE and ES. Methods We searched multiple databases from inception through July 2020 to identify studies that reported on safety and effectiveness of EUS-GE in comparison to ES. Pooled rates of technical success, clinical success, and adverse events (AEs) were calculated. Study heterogeneity was assessed using I 2 % and 95 % confidence interval. Results Five studies including 659 patients were included in our final analysis. Pooled rate of technical and clinical success for EUS-GE was 95.2 % (CI 87.2-.98.3, I 2 = 42) and 93.3 % (CI 84.4-97.3, I 2 = 59) while for ES it was 96.9 % (CI 90.9-99, I 2 = 64) and 85.6 % (CI 73-92.9, I 2 = 85), respectively. Pooled rate of re-intervention was significantly lower with EUS-GE i. e. 4 % (CI 1.8-8.7, I 2 = 35) compared to ES, where it was 23.6 % (CI 17.5-31, I 2 = 35), p = 0.001 . Pooled rates of overall and major AEs were comparable between the two techniques. Conclusion EUS-GE is comparable in terms of technical and clinical effectiveness and has a similar safety profile when compared to ES for palliation of GOO.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology, CHI Creighton University Medical Center, Omaha, Nebraska, United States
| | - Shahab R. Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA.
| | - Babu P. Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Aun R. Shah
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States
| | - Mohammad Bilal
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Daryl Ramai
- Internal Medicine, The Brooklyn Hospital Center, New York, United States
| | - Neil Bhogal
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States
| | - Banreet Dhindsa
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, Unites States
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Shailendra Singh
- Department of Medicine, West Virginia University Charleston Division, Charleston, West Virginia, United States
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, United States
| | - Andrew K. Nguyen
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Stephanie McDonough
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Douglas G. Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, United States
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Mohan BP, Canakis A, Khan SR, Chandan S, Ponnada S, McDonough S, Adler DG. Drug Eluting Versus Covered Metal Stents in Malignant Biliary Strictures-Is There a Clinical Benefit?: A Systematic Review and Meta-Analysis. J Clin Gastroenterol 2021; 55:271-277. [PMID: 32554989 DOI: 10.1097/mcg.0000000000001377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/11/2020] [Indexed: 01/11/2023]
Abstract
GOALS/BACKGROUND Patients with malignant biliary obstruction (MBO) often require transpapillary stenting for symptomatic relief and biliary decompression. Plastic stents and uncovered metal stents are now replaced by covered self-expanding metal stents (SEMS). However, stent occlusion from tumor overgrowth and chronic inflammation continues to be an issue. Drug-eluting stents (DES), through an antitumor paclitaxel membrane, have been used to combat this problem. The aim of this study was to conduct a meta-analysis comparing DES to SEMS in MBO. STUDY Multiple databases were searched to identify studies that compared the clinical outcomes of SEMS and DES in patients with MBO. Random-effects model was used to calculate the pooled odds ratio and the pooled individual outcomes. Our primary goals were to assess the stent patency and overall survival in days. Secondary outcomes assessed the individual reported adverse events and/or complications. RESULTS Five studies including 348 patients (175 males and 173 females) were included. The pooled odds ratio of stent patency was 1.03 (95% confidence interval: 0.68-1.54, P=0.9) and overall survival was 1.16 (95% confidence interval: 0.63-2.11, P=0.6). The pooled rate of stent patency was 168.3 (95% 140.7-196.4) days for DES and 149.4 (117.6-181.2) days for SEMS. The pooled rate of overall survival was 267.2 (206.2-328.2) days for DES and 218.2 (148.5-287.8) days for SEMS. CONCLUSION On the basis of this meta-analysis, DES and SEMS seem to demonstrate comparable clinical outcomes in patients with malignant biliary strictures. Reported adverse events and/or complications were comparable as well.
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Affiliation(s)
- Babu P Mohan
- Department of Internal Medicine, Banner University Medical Center, University of Arizona, Tucson, AZ
| | - Andrew Canakis
- Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Shahab R Khan
- Department of Gastroenterology, Rush University Medical Center, Chicago, IL
| | - Saurabh Chandan
- Department of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE
| | - Suresh Ponnada
- Department of Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, VA
| | - Stephanie McDonough
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
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Mohan BP, Khan SR, Kassab LL, Ponnada S, Chandan S, Ali T, Dulai PS, Adler DG, Kochhar GS. High pooled performance of convolutional neural networks in computer-aided diagnosis of GI ulcers and/or hemorrhage on wireless capsule endoscopy images: a systematic review and meta-analysis. Gastrointest Endosc 2021; 93:356-364.e4. [PMID: 32721487 DOI: 10.1016/j.gie.2020.07.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Diagnosis of GI ulcers and/or hemorrhage by wireless capsule endoscopy (WCE) is limited by the physician-dependent, tedious, time-consuming process of image and/ or video classification. Computer-aided diagnosis (CAD) by convolutional neural network (CNN)-based machine learning may help reduce this burden. Our aim was to conduct a meta-analysis and appraise the reported data. METHODS Multiple databases were searched (from inception to November 2019), and studies that reported on the performance of CNN in the diagnosis of GI ulcerations and/or hemorrhage on WCE were selected. A random-effects model was used to calculate the pooled rates. In cases where multiple 2 × 2 contingency tables were provided for different thresholds, we assumed the data tables were independent from each other. Heterogeneity was assessed by I2% and 95% prediction intervals. RESULTS Nine studies were included in our final analysis that evaluated the performance of CNN-based CAD of GI ulcers and/or hemorrhage by WCE. The pooled accuracy was 95.4% (95% confidence interval [CI], 94.3-96.3), sensitivity was 95.5% (95% CI, 94-96.5), specificity was 95.8% (95% CI, 94.7-96.6), positive predictive value was 95.8% (95% CI, 90.5-98.2), and negative predictive value was 96.8% (95% CI, 94.9-98.1). I2% heterogeneity was negligible except for the pooled positive predictive value. CONCLUSIONS Based on our meta-analysis, CNN-based CAD of GI ulcerations and/or hemorrhage on WCE achieves a high-level performance. The quality of the evidence is robust, and therefore CNN-based CAD has the potential to become the first choice of machine learning to optimize WCE image/video reading.
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Affiliation(s)
- Babu P Mohan
- Gastroenterology & Hepatology, University of Utah, Salt Lake City, Utah, USA
| | - Shahab R Khan
- Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Lena L Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Suresh Ponnada
- Internal Medicine, Roanoke Medical Center, Roanoke, Virginia, USA
| | - Saurabh Chandan
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tauseef Ali
- Gastroenterology, University of Oklahoma/Saint Anthony Hospital, Oklahoma City, Oklahoma, USA
| | - Parambir S Dulai
- Gastroenterology and Hepatology, University of California, San Diego, California, USA
| | - Douglas G Adler
- Gastroenterology & Hepatology, University of Utah, Salt Lake City, Utah, USA
| | - Gursimran S Kochhar
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Chandan S, Mohan BP, Khan SR, Facciorusso A, Ramai D, Kassab LL, Bhogal N, Asokkumar R, Lopez-Nava G, McDonough S, Adler DG. Efficacy and Safety of Intragastric Balloon (IGB) in Non-alcoholic Fatty Liver Disease (NAFLD): a Comprehensive Review and Meta-analysis. Obes Surg 2021; 31:1271-1279. [PMID: 33409973 DOI: 10.1007/s11695-020-05084-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 02/07/2023]
Abstract
Intragastric balloon (IGB) therapy has shown efficacy in weight loss but its role in NAFLD remains unknown. We conducted a systematic review and meta-analysis to evaluate the efficacy of IGB in NAFLD. Meta-analysis was performed to estimate the pooled proportion of patients with improvement in steatosis as determined by imaging and histology following IGB placement. Nine studies were included in our analysis. Four hundred forty-two IGBs were placed. Improvement in steatosis was seen in 79.2% of patients and NAS in 83.5% of patients, and HOMA-IR score improved in 64.5% of patients. A reduction in liver volume by CT scan was noticed in 93.9% of patients undergoing IGB placement. IGB is an effective and safe short-term therapeutic modality for patients with NAFLD.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA
| | - Shahab R Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, IL, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Daryl Ramai
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | | | - Neil Bhogal
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ravishankar Asokkumar
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Gortrand Lopez-Nava
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore, Singapore
| | - Stephanie McDonough
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, 30N 1900E 4R118, Salt Lake City, UT, 84132, USA.
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Chandan S, Mohan BP, Khan SR, Bhogal N, Ramai D, Bilal M, Aziz M, Shah AR, Mashiana HS, Jha LK, Bhat I, Singh S, Adler DG. Adenoma and polyp detection rates during insertion versus withdrawal phase of colonoscopy: a systematic review and meta-analysis of randomized controlled trials. Gastrointest Endosc 2021; 93:68-76.e2. [PMID: 32540312 DOI: 10.1016/j.gie.2020.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colonoscopy is the preferred modality for colorectal cancer screening because it has both diagnostic and therapeutic capabilities. Current consensus states that colonoscopy should be performed with initial rapid passage of the instrument to the cecum, followed by thorough evaluation for and removal of all polyps during a deliberate slow withdrawal. Reports have suggested that polyps that are seen but not removed during insertion are sometimes quite difficult to find during withdrawal. METHODS We performed a comprehensive literature search of several major databases (from inception to March 2020) to identify randomized controlled trials comparing inspection and polypectomy during the insertion phase as opposed to the traditional practice of inspection and polypectomy performed entirely during the withdrawal phase. We examined differences in terms of adenoma detection rate (ADR), polyps detected per patient (PDPP), cecal intubation time (CIT), withdrawal time, and total procedure time. RESULTS Seven randomized controlled trials, including 3834 patients, were included in our final analysis. The insertion/withdrawal cohort had 1951 patients and the withdrawal-only cohort 1883 patients. Pooled odds of adenoma detection in the insertion/withdrawal cohort was .99 (P = .8). ADR was 47.2% in the insertion/withdrawal cohort and 48.6% in the withdrawal-only cohort. Although total procedure and withdrawal times were shorter in the insertion/withdrawal cohort, PDPP in both cohorts were not statistically significant (1.4 vs 1.5, P = .7). CONCLUSIONS Additional inspection and polypectomy during the insertion and withdrawal phases of colonoscopy offer no additional benefit in terms of ADR or PDPP.
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Affiliation(s)
- Saurabh Chandan
- Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Babu P Mohan
- Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, USA
| | - Shahab R Khan
- Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Neil Bhogal
- Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daryl Ramai
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, New York, USA
| | - Mohammad Bilal
- Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Muhammad Aziz
- Internal Medicine, University of Toledo, Toledo, Ohio, USA
| | - Aun R Shah
- Internal Medicine, Metro Health, Cleveland, Ohio, USA
| | - Harmeet S Mashiana
- Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lokesh K Jha
- Gastroenterology, Parkview Health, Fort Wayne, Indiana, USA
| | - Ishfaq Bhat
- Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shailender Singh
- Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Mohan BP, Khan SR, Chandan S, Kassab LL, Ponnada S, Asokkumar R, Shen B, Iacucci M, Navaneethan U. Endoscopic resection of colon dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis. Gastrointest Endosc 2021; 93:59-67.e10. [PMID: 32592777 DOI: 10.1016/j.gie.2020.06.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD) is a well-known risk factor for colorectal cancer (CRC). Current guidelines propose complete endoscopic resection of dysplasia in IBD patients with close endoscopic follow-up. Current data on the risk of neoplasia after endoscopic resection of dysplasia in IBD patients are limited. METHODS Multiple databases were searched from inception through August 2019 to identify studies that reported on incidence and/or recurrence of neoplasia after resection of dysplasia in patients with IBD. Outcomes from the included studies were pooled to estimate the risk of neoplasia after dysplasia resection in IBD patients. RESULTS From 18 studies, 1037 IBD patients underwent endoscopic resection for a total of 1428 colonic lesions. After lesion resection, the pooled risk (rate per 1000 person-years of follow-up) of CRC was 2 (95% confidence interval [CI], 0-3), the pooled risk of high-grade dysplasia was 2 (95% CI, 1-3), and the pooled risk of any lesion was 43 (95% CI, 30-57). Meta-regression analysis based on lesion location (right, left), lesion size (mean and/or median size in mm), lesion type (Paris type I, Paris type II), endoscopic resection technique (EMR, endoscopic submucosal dissection, or polypectomy), and lesion histology (low-grade dysplasia, high-grade dysplasia) did not influence the reported outcomes. CONCLUSIONS Risk of CRC after dysplasia resection in IBD patients appears to be low, supporting the current strategy of resection and surveillance.
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Affiliation(s)
- Babu P Mohan
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, USA
| | - Shahab R Khan
- Gastroenterology, Rush University Medical Center, Chicago, Illinois, USA
| | - Saurabh Chandan
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lena L Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minneapolis, USA
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia, USA
| | | | - Bo Shen
- IBD Center, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Marietta Iacucci
- Institute Translational of Medicine, Institute of Immunology and Immunotherapy and NIHR Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Mohan BP, Facciorusso A, Khan SR, Chandan S, Kassab LL, Gkolfakis P, Tziatzios G, Triantafyllou K, Adler DG. Real-time computer aided colonoscopy versus standard colonoscopy for improving adenoma detection rate: A meta-analysis of randomized-controlled trials. EClinicalMedicine 2020; 29-30:100622. [PMID: 33294821 PMCID: PMC7691740 DOI: 10.1016/j.eclinm.2020.100622] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Recent prospective randomized controlled trials have evaluated deep convolutional neural network (CNN) based computer aided detection (CADe) of lesions in real-time colonoscopy. We conducted this meta-analysis to compare the adenoma detection rate (ADR) of deep CNN based CADe assisted colonoscopy to standard colonoscopy (SC) from randomized controlled trials (RCTs). METHODS Multiple databases were searched (from inception to May 2020) and parallel RCTs that compared deep CNN based CADe assisted colonoscopy to SC were included for this analysis. Using Mantel-Haenzel (M-H) random effects model, pooled risk ratios (RR) and mean difference (MD) were calculated. In between study heterogeneity was assessed by I2% values. Outcomes assessed included other per patient adenoma parameters. FINDINGS Six RCTs were included in our final analysis that utilized deep CNN based CADe system in real-time colonoscopy. Total numbers of patients assessed were 4962 (2480 in CADe and 2482 in SC group). CADe based colonoscopy demonstrated statistically higher pooled ADR, RR=1.5 (95% CI 1.3-1.72), p<0.0001, I2=56%; and pooled PDR, RR=1.42 (95% CI 1.33-1.51), p<0.00001, I2=9%; when compared to SC. Per patient adenoma detection parameters were significantly better with CADe colonoscopy when compared to SC, with increased scope withdrawal time (mean difference = 0.38, 95% CI 0.05-0.72, p = 0.02). INTERPRETATION Based on our meta-analysis, deep CNN based CADe colonoscopy achieved significantly higher ADR metrics, albeit with increased scope withdrawal time when compared to SC.
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Affiliation(s)
- Babu P. Mohan
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Antonio Facciorusso
- Gastroenterology Unit, University of Foggia, Foggia, Italy
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Shahab R. Khan
- Gastroenterology, Rush University Medical Center, Chicago, IL, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Saurabh Chandan
- Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Lena L. Kassab
- Internal Medicine, Mayo Clinic, Rochester, MIN, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, 2nd Dep of Internal Medicine – Propaedeutic Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Georgios Tziatzios
- Hepatogastroenterology Unit, 2nd Dep of Internal Medicine – Propaedeutic Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, 2nd Dep of Internal Medicine – Propaedeutic Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
| | - Douglas G. Adler
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT, USA
- Gastroenterology and Hepatology, University of Colorado Anshchutz Medical Campus, Aurora, CO, USA
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Mohan BP, Khan SR, Kassab LL, Ponnada S, Dulai PS, Kochhar GS. Accuracy of convolutional neural network-based artificial intelligence in diagnosis of gastrointestinal lesions based on endoscopic images: A systematic review and meta-analysis. Endosc Int Open 2020; 8:E1584-E1594. [PMID: 33140014 PMCID: PMC7581460 DOI: 10.1055/a-1236-3007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/08/2020] [Indexed: 12/29/2022] Open
Abstract
Background and study aims Recently, a growing body of evidence has been amassed on evaluation of artificial intelligence (AI) known as deep learning in computer-aided diagnosis of gastrointestinal lesions by means of convolutional neural networks (CNN). We conducted this meta-analysis to study pooled rates of performance for CNN-based AI in diagnosis of gastrointestinal neoplasia from endoscopic images. Methods Multiple databases were searched (from inception to November 2019) and studies that reported on the performance of AI by means of CNN in the diagnosis of gastrointestinal tumors were selected. A random effects model was used and pooled accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Pooled rates were categorized based on the gastrointestinal location of lesion (esophagus, stomach and colorectum). Results Nineteen studies were included in our final analysis. The pooled accuracy of CNN in esophageal neoplasia was 87.2 % (76-93.6) and NPV was 92.1 % (85.9-95.7); the accuracy in lesions of stomach was 85.8 % (79.8-90.3) and NPV was 92.1 % (85.9-95.7); and in colorectal neoplasia the accuracy was 89.9 % (82-94.7) and NPV was 94.3 % (86.4-97.7). Conclusions Based on our meta-analysis, CNN-based AI achieved high accuracy in diagnosis of lesions in esophagus, stomach, and colorectum.
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Affiliation(s)
- Babu P Mohan
- Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, Utah, United States
| | - Shahab R Khan
- Gastroenterology, Rush University Medical Center, Chicago, Illinois, United States
| | - Lena L Kassab
- Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States
| | - Suresh Ponnada
- Internal Medicine, Roanoke Medical Center, Roanoke, Virginia, United States
| | - Parambir S Dulai
- Gastroenterology and Hepatology, University of California, San Diego, California, United States
| | - Gursimran S Kochhar
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
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