Techniques and Innovations in Gastrointestinal Endoscopy最新文献

Endoscopic Repair for Sleeve Gastrectomy Leaks Is Associated With a High Rate of Leak Resolution 袖状胃切除术渗漏的内镜修复与高渗漏解决率有关

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-10-15 DOI: 10.1016/j.tige.2024.09.004

Khalid Fahoum , Tamara Kahan , Olivia Delau , Matthew Fasullo , Ki-Yoon Kim , Lauren Khanna , Gregory Haber , Paresh C. Shah , Tamas Gonda

BACKGROUND AND AIMS

Staple line leaks following sleeve gastrectomy have significant morbidity and mortality. Endoscopic repair approaches are increasingly being used and studied, but follow-up time is limited, and more data are needed. Our primary aim was to describe long-term outcomes following repair; secondary aims were to compare repair approaches and assess factors associated with clinical success.

METHODS

We conducted an observational cohort study of patients who underwent endoscopic repair of a sleeve gastrectomy leak from 2017 to 2023 at our tertiary care center. Patients without available follow-up were excluded. Electronic medical records were reviewed to obtain baseline and clinical characteristics; long-term outcomes were ascertained from the electronic medical record and telephonic conversations with patients. Repairs were classified as drainage when transmural stents were placed and as closure when clips, sutures, and/or an intraluminal stent was placed.

RESULTS

A total of 30 patients were included. The majority were females (77%) and Whites (74%), with a median age of 41.0 years (IQR, 35.1-51.8 years). The majority of patients (70%) initially underwent drainage, while the rest underwent closure. Median follow-up time was 1.2 years (IQR, 0.6 -1.6 years). Success rates for the initial repair approach without crossover or requiring surgical repair were 71.4% for drainage and 22.2% for closure (P = 0.02). Overall, 24 (80%) patients had leak resolution at the last follow-up, and the median number of endoscopies was 3 (IQR, 2-4).

CONCLUSION

Our study demonstrates a high rate of long-term leak resolution following endoscopic repair of sleeve gastrectomy leaks. An initial drainage approach may be associated with higher clinical success, although this was not noted in the multivariable analysis. Prospective randomized multicenter studies are needed to further evaluate and compare repair approaches.

背景和目的袖带胃切除术后绦虫线漏的发病率和死亡率都很高。内镜修复方法的使用和研究越来越多，但随访时间有限，需要更多数据。我们的主要目的是描述修复后的长期预后；次要目的是比较修复方法并评估与临床成功相关的因素。方法我们对 2017 年至 2023 年期间在我们的三级医疗中心接受内镜修复袖状胃切除术漏的患者进行了一项观察性队列研究。没有随访的患者被排除在外。研究人员查阅了电子病历，以获得基线和临床特征；通过电子病历和与患者的电话交谈确定了长期结果。放置经膜支架的修复分为引流修复，放置夹子、缝合线和/或腔内支架的修复分为闭合修复。大多数患者为女性（77%）和白人（74%），中位年龄为 41.0 岁（IQR，35.1-51.8 岁）。大多数患者（70%）最初接受了引流术，其余患者则接受了闭合术。中位随访时间为 1.2 年（IQR，0.6-1.6 年）。在没有交叉或需要手术修复的情况下，初始修复方法的成功率为：引流 71.4%，闭合 22.2%（P = 0.02）。结论：我们的研究表明，袖带胃切除术渗漏内镜修复后，长期渗漏解决率很高。最初的引流方法可能与临床成功率较高有关，但在多变量分析中并未注意到这一点。需要进行前瞻性随机多中心研究，以进一步评估和比较修复方法。

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引用次数: 0

The Endoscopic Role and Indications of Through-the-Scope Tack and Suture System for Gastrointestinal Closure 用于胃肠道缝合的镜下粘合剂和缝合系统的内窥镜作用和适应症

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-10-11 DOI: 10.1016/j.tige.2024.09.005

Andrew Canakis , Abdulhameed Al-Sabban , Shayan S. Irani

The development of endoscopic closure devices has revolutionized management options for gastrointestinal defects. The endoscopists’ toolbox has expanded from through-the-scope clips to over-the-scope clips and over-the-scope suturing. The over-the-scope devices are somewhat limited by the target location, maneuverability, and need for device withdrawal for application. The introduction of a novel through-the-scope helix tack suture system enhances the toolbox for defect closure as this device can provide closure throughout the gastrointestinal tract without the need for endoscope withdrawal. Its user-friendly design and compatibility with standard endoscopes allows for complex tissues approximation in challenging locations. Since its approval by the Federal Drug Agency in December 2020, studies have investigated its utility for all types of defects, including perforations, leaks, fistulas, endoscopic resections sites, and even stent fixation. In this review, we will investigate the versatility of this device to understand its role in primary defect closure.

内窥镜闭合装置的发展彻底改变了胃肠道缺损的治疗方案。内镜医师的工具箱从镜下夹扩大到镜上夹和镜下缝合。由于目标位置、可操作性和应用时需要拔出器械等原因，镜下器械在一定程度上受到了限制。新型镜下螺旋粘合缝合系统的引入增强了缺陷缝合的工具箱，因为这种装置可以在整个胃肠道内进行缝合，而无需撤出内窥镜。它的设计方便用户使用，并与标准内窥镜兼容，可在具有挑战性的位置对复杂组织进行近似缝合。自 2020 年 12 月获得联邦药品管理局批准以来，已有研究对其在各种类型的缺陷中的实用性进行了调查，包括穿孔、渗漏、瘘管、内镜切除部位，甚至支架固定。在这篇综述中，我们将研究这种装置的多功能性，以了解它在初级缺陷闭合中的作用。

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引用次数: 0

Endoscopic Transpapillary Gallbladder Drainage With 2 Stents Versus 1 Stent Reduces Reinterventions: A Multicenter Study

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-10-11 DOI: 10.1016/j.tige.2024.09.006

James D. Haddad , Natalie Wilson , Vijay S. Are , Shawn L. Shah , Danny Issa , Tarek Sawas , Mohammad Bilal , Thomas Tielleman

BACKGROUND AND AIMS

Endoscopic transpapillary gallbladder drainage (ETGBD) is a therapeutic option for gallstone-related gallbladder disease in nonsurgical candidates. However, the optimal stenting strategy and follow-up has not been established. We aimed to determine whether there was a decreased need for unplanned reintervention in patients undergoing placement of two transpapillary gallbladder stents compared with that in those undergoing placement of one stent.

METHODS

We performed a multicenter retrospective analysis of patients undergoing ETGBD between June 2013 and October 2022. The primary outcome was clinical success as defined by resolution of symptoms without the need for another drainage strategy. Secondary outcomes included the adverse events of postendoscopic retrograde cholangiopancreatography pancreatitis, cholangitis, bleeding, perforation, or death. Factors associated with placement of two stents, unplanned reintervention, and adverse events were assessed.

RESULTS

We included 75 patients who underwent ETGBD, with a median follow-up of 407 days (IQR: 71-1504 days). Technical and clinical success were 88.2% and 81.3%, respectively. Unplanned reintervention was significantly lower in the double stenting group (0% vs 25.4%; P = 0.02). Use of a 7 French stent (odds ratio [OR]: 15.5; 95% CI: 1.9-125; P = 0.01) and presence of a percutaneous cholecystostomy tube (OR: 10.8; 95% CI: 2.8-41.3; P = 0.001) were associated with placement of two stents. There was no significant difference in adverse events between groups (OR: 0.9; 95% CI: 0.09-8.8; P = 0.94).

CONCLUSION

ETGBD is safe and effective in nonoperative candidates. Single transpapillary gallbladder stenting is associated with more unplanned reinterventions, and 7 French stent diameter and previous percutaneous cholecystostomy tube may be associated with ability to place a second stent. Endoscopists should consider planned exchange of solitary transpapillary gallbladder stents or interval placement of a second stent if placement of two stents was unsuccessful at the index procedure.

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引用次数: 0

Pancreatic Cancer Screening: A Narrative Review 胰腺癌筛查：叙述性综述

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.08.001

Jihane Meziani, Gwenny M. Fuhler, Marco J. Bruno, Djuna L. Cahen, Kasper A. Overbeek

Pancreatic cancer (PC) is one of the most lethal cancer types. Despite advancements that have led to some modest improvements in survival rates over the past decade, PC still has a dismal prognosis. Patients diagnosed with early-stage disease have higher survival rates. Unfortunately, PC seldom manifests itself early, and symptoms prompting diagnostic investigations usually develop when the disease is already advanced. PC screening may lead to better patient outcomes through detection of asymptomatic early-stage cancers and precursor lesions. Population-based screening is deemed unfeasible because of the low incidence of PC. However, screening of individuals with an inherited lifetime risk of ≥5%-10% for developing PC may prove beneficial. In the context of high-risk individuals, screening is referred to as surveillance. Yet, critical aspects such as suitable candidates for surveillance, the ideal time to initiate and discontinue surveillance, as well as the most effective surveillance method, preferred surveillance modalities, and optimal surveillance interval remain unclear. Herein, we summarize the current state of knowledge regarding PC surveillance by reviewing current expert consensus statements and guidelines. In addition, we review the management of identified lesions, the yield in different cohorts, and future directions to improve the outcomes of individuals at high-risk of developing PC.

胰腺癌（PC）是致死率最高的癌症类型之一。尽管在过去十年中取得了一些进展，使存活率略有提高，但胰腺癌的预后仍然不容乐观。早期诊断的患者生存率更高。不幸的是，PC 很少在早期出现，通常在疾病晚期才会出现促使诊断检查的症状。PC 筛查可通过检测无症状的早期癌症和前驱病变，为患者带来更好的治疗效果。由于 PC 发病率较低，基于人群的筛查被认为是不可行的。不过，对终生遗传性 PC 风险≥5%-10% 的个体进行筛查可能会证明是有益的。在高危人群中，筛查被称为监测。然而，监测的合适人选、启动和终止监测的理想时间、最有效的监测方法、首选监测模式和最佳监测间隔等关键问题仍不明确。在此，我们通过回顾当前的专家共识声明和指南，总结了有关 PC 监测的知识现状。此外，我们还回顾了对已发现病变的管理、不同队列的收益以及改善 PC 高危人群预后的未来方向。

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引用次数: 0

Reducing the Carbon Footprint of Colorectal Cancer Screening 减少大肠癌筛查的碳足迹

IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.03.006

Swapna Gayam , Aasma Shaukat

Climate change is the largest public health threat of the 21st century. Gastrointestinal endoscopy is the second overall waste generator and third highest hazardous waste generator in a hospital setting, making it essential for all gastroenterologists to reexamine their practices to reduce this negative impact. Colorectal cancer (CRC) is a major contributor to the gastrointestinal disease burden, and CRC screening is a vital component of age-appropriate cancer screening in the United States. Along the spectrum of colon cancer screening methods, considerations regarding their environmental impact are gaining prominence. Consequently, focusing mitigation strategies on CRC screening is justified. Mitigation strategies focused on CRC screening are likely to have a measurable impact on reducing the environmental impact of endoscopy, given the stark volume of procedures performed in the United States. In this paper, we review the different CRC screening options and strategies to reduce the environmental impact of these processes.

气候变化是 21 世纪最大的公共卫生威胁。在医院环境中，消化道内窥镜检查是第二大废物产生者和第三大有害废物产生者，因此所有消化内科医生都必须重新审视自己的工作，以减少这种负面影响。结肠直肠癌（CRC）是造成胃肠道疾病负担的主要因素，在美国，CRC 筛查是适龄癌症筛查的重要组成部分。在各种结肠癌筛查方法中，对其环境影响的考虑日益突出。因此，将缓解策略的重点放在 CRC 筛查上是合理的。鉴于美国内镜检查的数量巨大，以 CRC 筛查为重点的缓解策略很可能会对减少内镜检查对环境的影响产生可衡量的影响。在本文中，我们回顾了不同的 CRC 筛查方案以及减少这些过程对环境影响的策略。

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引用次数: 0

Semaglutide Is an Independent Predictor of Retained Solid Gastric Contents, but Same-Day Colonoscopy Mitigates Effect 塞马鲁肽是滞留固体胃内容物的独立预测因子，但当日结肠镜检查可减轻影响

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.07.001

Haarika Korlipara , Jason Chua , Adam Buckholz , Jacob Jamison , Ariel Gonzalez , Sonal Kumar , Marissa Weber , Sanjay Salgado , Reem Sharaiha , Carolyn Newberry

BACKGROUND AND AIMS

Glucagon-like peptide-1 receptor agonists are commonly prescribed for diabetes and obesity; however, their use may complicate anesthetized procedures due to delayed gastric emptying. This study sought to define rates of retained solid gastric contents, a risk factor for periprocedural complications, in a population taking semaglutide.

METHODS

This is a retrospective cohort study comparing individuals undergoing upper endoscopy over a 5-year period at a tertiary care center who were prescribed semaglutide, a long-acting glucagon-like peptide-1 receptor agonist, for >4 weeks against a matched control cohort not on the medication. Multivariant logistic regression and multivariable propensity-matched association analysis were conducted to compare outcomes of interest, including retained solid gastric contents, endoscopic complications, and endoscopic outcomes.

RESULTS

In total, 1212 patients comprised the study population (602 on semaglutide, 610 not on semaglutide). On multivariant logistic regression analyzing causes of delayed gastric emptying, semaglutide was an independent risk factor for retained solid gastric contents (odds ratio [OR], 4.74; 95% CI, 2.40-9.35; P < 0.0001). On multivariable propensity-matched association analysis utilizing demographic and clinical characteristics, semaglutide use was associated with an absolute increase of 6% of retained solid gastric contents (coefficient, 0.0644; 95% CI, 0.034-0.095; P < 0.0001). Same-day colonoscopy was protective against this finding (OR, 0.41; 95% CI, 0.23-0.73; P = 0.003). Intubation was rare and not associated with semaglutide use (OR, 0.70; 95% CI, 0.30-1.64; P = 0.41). No periprocedural aspiration events occurred.

CONCLUSION

Semaglutide was an independent risk factor for retained solid gastric contents, even when accounting for confounding factors. This was negated in patients undergoing same-day colonoscopy, indicating an opportunity for preprocedural fasting protocols in the absence of medication hold.

背景和目的胰高血糖素样肽-1 受体激动剂是治疗糖尿病和肥胖症的常用处方药；然而，由于胃排空延迟，使用这种药物可能会使麻醉手术复杂化。这是一项回顾性队列研究，比较了在一家三级医疗中心接受上内镜检查的患者与未使用该药物的匹配对照组的情况，前者在5年时间里服用了长效胰高血糖素样肽-1受体激动剂--塞马鲁肽4周，后者在4周时间里服用了塞马鲁肽4周。研究人员进行了多变量逻辑回归和多变量倾向匹配关联分析，以比较相关结果，包括滞留的固态胃内容物、内镜并发症和内镜结果。多变量逻辑回归分析了胃排空延迟的原因，结果显示，塞马鲁肽是固体胃内容物滞留的独立风险因素（几率比 [OR]，4.74；95% CI，2.40-9.35；P <；0.0001）。在利用人口统计学和临床特征进行的多变量倾向匹配关联分析中，使用塞马鲁肽与固性胃内容物滞留率绝对值增加6%有关（系数为0.0644；95% CI为0.034-0.095；P <；0.0001）。当天的结肠镜检查对这一结果具有保护作用（OR，0.41；95% CI，0.23-0.73；P = 0.003）。插管很少见，且与使用塞马鲁肽无关（OR，0.70；95% CI，0.30-1.64；P = 0.41）。结论即使考虑到混杂因素，塞马鲁肽也是固体胃内容物滞留的独立风险因素。接受当天结肠镜检查的患者不会出现这种情况，这表明在没有药物保留的情况下，可以在术前禁食。

{"title":"Semaglutide Is an Independent Predictor of Retained Solid Gastric Contents, but Same-Day Colonoscopy Mitigates Effect","authors":"Haarika Korlipara , Jason Chua , Adam Buckholz , Jacob Jamison , Ariel Gonzalez , Sonal Kumar , Marissa Weber , Sanjay Salgado , Reem Sharaiha , Carolyn Newberry","doi":"10.1016/j.tige.2024.07.001","DOIUrl":"10.1016/j.tige.2024.07.001","url":null,"abstract":"<div><h3>BACKGROUND AND AIMS</h3><div>Glucagon-like peptide-1 receptor agonists are commonly prescribed for diabetes and obesity; however, their use may complicate anesthetized procedures due to delayed gastric emptying. This study sought to define rates of retained solid gastric contents, a risk factor for periprocedural complications, in a population taking semaglutide.</div></div><div><h3>METHODS</h3><div>This is a retrospective cohort study comparing individuals undergoing upper endoscopy over a 5-year period at a tertiary care center who were prescribed semaglutide, a long-acting glucagon-like peptide-1 receptor agonist, for >4 weeks against a matched control cohort not on the medication. Multivariant logistic regression and multivariable propensity-matched association analysis were conducted to compare outcomes of interest, including retained solid gastric contents, endoscopic complications, and endoscopic outcomes.</div></div><div><h3>RESULTS</h3><div>In total, 1212 patients comprised the study population (602 on semaglutide, 610 not on semaglutide). On multivariant logistic regression analyzing causes of delayed gastric emptying, semaglutide was an independent risk factor for retained solid gastric contents (odds ratio [OR], 4.74; 95% CI, 2.40-9.35; <em>P</em> < 0.0001). On multivariable propensity-matched association analysis utilizing demographic and clinical characteristics, semaglutide use was associated with an absolute increase of 6% of retained solid gastric contents (coefficient, 0.0644; 95% CI, 0.034-0.095; <em>P</em> < 0.0001). Same-day colonoscopy was protective against this finding (OR, 0.41; 95% CI, 0.23-0.73; <em>P</em> = 0.003). Intubation was rare and not associated with semaglutide use (OR, 0.70; 95% CI, 0.30-1.64; <em>P</em> = 0.41). No periprocedural aspiration events occurred.</div></div><div><h3>CONCLUSION</h3><div>Semaglutide was an independent risk factor for retained solid gastric contents, even when accounting for confounding factors. This was negated in patients undergoing same-day colonoscopy, indicating an opportunity for preprocedural fasting protocols in the absence of medication hold.</div></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"26 4","pages":"Pages 316-322"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142533693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Step-Up Strategy for Endoscopic Hemostasis Using PuraStat After Endoscopic Sphincterotomy Bleeding (STOP Trial) 内镜括约肌切开术出血后使用 PuraStat 的内镜止血阶梯策略（STOP 试验）

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.03.005

Background and Aims

Recently, a novel self-assembling peptide hemostatic gel (PuraStat) has become available. Although PuraStat for endoscopic sphincterotomy (EST) bleeding has been evaluated and reported mainly in case reports and several retrospective studies, no prospective evaluation has been reported. The aim of the present study was to prospectively evaluate the safety and efficacy of PuraStat for persistent EST bleeding >120 seconds as a first-line endoscopic hemostasis technique.

Methods

This single-arm, prospective study was conducted between November 2022 and August 2023. As the primary technique for endoscopic hemostasis, PuraStat was applied first. If hemostasis failed, other techniques were used. The primary outcome of the present study was to evaluate the technical success rate of the application of PuraStat to the bleeding site. Clinical success was defined as the absence of oozing for 180 seconds after PuraStat application. Adverse events associated with procedures and secondary hemorrhage were secondary outcomes. PuraStat application was performed using the embankment method.

Results

During the study period, 1080 endoscopic retrograde cholangiopancreatography procedures were performed. A total of 108 patients experienced complications with EST bleeding. Among them, endoscopic hemostasis was required in 51 patients. These patients enrolled in this prospective study. All patients successfully underwent PuraStat application without PuraStat dislocation into the third part of the duodenum. The technical success rate of endoscopic hemostasis using PuraStat was 98% (50/51). As possible factors associated with secondary hemorrhage, biliary stents, including plastic or metal stents, were deployed in 60.7% (31/51). Finally, severe adverse events associated with the procedures were not observed in any patients, although mild acute pancreatitis was observed in 2 patients, and conservative treatment was successful.

Conclusion

In conclusion, PuraStat application may be safe for oozing after EST without increasing the frequency of acute pancreatitis.

背景和目的最近，一种新型自组装多肽止血凝胶（PuraStat）问世。虽然 PuraStat 用于内镜括约肌切开术（EST）出血的评估和报告主要见于病例报告和几项回顾性研究，但尚未见前瞻性评估报告。本研究旨在前瞻性地评估 PuraStat 作为一线内镜止血技术在治疗EST持续出血>120 秒的安全性和有效性。作为内镜止血的主要技术，首先应用 PuraStat。如果止血失败，则使用其他技术。本研究的主要结果是评估在出血部位应用 PuraStat 的技术成功率。临床成功的定义是使用 PuraStat 后 180 秒内无渗血。与手术相关的不良事件和继发性出血是次要结果。研究期间共进行了 1080 例内镜逆行胰胆管造影术。共有 108 名患者出现EST出血并发症。其中 51 例患者需要内镜止血。这些患者参加了这项前瞻性研究。所有患者都成功应用了 PuraStat，且 PuraStat 没有移位到十二指肠的第三部分。使用 PuraStat 进行内镜止血的技术成功率为 98%（50/51）。60.7%（31/51）的患者使用了胆道支架，包括塑料或金属支架，这可能是继发性出血的相关因素。最后，尽管有 2 名患者出现了轻微的急性胰腺炎，但没有发现任何与手术相关的严重不良事件，保守治疗也取得了成功。

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引用次数: 0

Sphincterotomy vs Sham Procedure for Pain Relief in Sphincter of Oddi Dysfunction: Systematic Review and Meta-analysis 括约肌切开术与用于缓解奥奇氏括约肌功能障碍患者疼痛的假手术：系统回顾和元分析

IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2023.10.003

Dennis Wang, Kayla Dadgar, Mohammad Yaghoobi

Background and Aims

Endoscopic sphincterotomy (ES) used to be part of sphincter of Oddi dysfunction (SOD) management, but recent studies changed attitudes about its utility. We conducted a systematic review and meta-analysis of randomized sham-controlled trials (RCTs) investigating ES for biliary SOD-related pain.

Methods

Articles were retrieved from PubMed, Medline, Embase, and CENTRAL. We included RCTs comparing ES with a sham procedure on post-cholecystectomy patients ≥18 years old with biliary SOD. Standardized data collection sheets were used, as well as the Risk of Bias 2 tool. A random-effects model was used to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Subgroups included normal vs abnormal sphincter of Oddi manometry (SOM) and type II vs III SOD.

Results

From 517 articles retrieved, 4 RCTs were included, encompassing 376 patients. Overall, no difference existed between ES and the sham procedure in improving biliary SOD-related pain overall (RR 1.32, 95% CI 0.77-2.26, P = .31) and for the normal (RR 0.83, 95% CI 0.42-1.65, P = .60) and abnormal SOM subgroups (RR 1.90, 95% CI 0.84-4.29, P = .12). ES was numerically favored over the sham procedure in patients with type II (RR 2.51, 95% CI 1.32-4.81, P = .005) but not type III SOD (RR 1.02, 95% CI 0.32-3.27, P = .98). However, there was no significant subgroup difference between these type-based subgroups (P = .18, I² = 43.2%).

Conclusion

ES does not improve biliary SOD-related pain overall or for type II vs III SOD or normal vs abnormal SOM subgroups. This meta-analysis confirms that there is no proven role for SOM or ES in managing SOD.

背景和目的内镜下括约肌切开术（ES）曾是奥奇括约肌功能障碍（SOD）治疗的一部分，但最近的研究改变了人们对其效用的看法。我们对研究 ES 治疗胆道 SOD 相关疼痛的随机假对照试验（RCT）进行了系统回顾和荟萃分析。我们纳入了对胆囊切除术后年龄≥18 岁的胆道 SOD 患者进行 ES 与假手术比较的 RCT。我们使用了标准化数据收集表和偏倚风险 2 工具。采用随机效应模型计算风险比 (RR) 和 95% 置信区间 (CI)。亚组包括正常与异常Oddi括约肌测压（SOM）和II型与III型SOD。结果从检索到的517篇文章中，共纳入了4项RCT，涉及376名患者。总体而言，ES 与假手术在改善胆道 SOD 相关疼痛方面没有差异（RR 1.32，95% CI 0.77-2.26，P = .31），正常（RR 0.83，95% CI 0.42-1.65，P = .60）和异常 SOM 亚组（RR 1.90，95% CI 0.84-4.29，P = .12）也没有差异。在 II 型（RR 2.51，95% CI 1.32-4.81，P = .005）而非 III 型 SOD（RR 1.02，95% CI 0.32-3.27，P = .98）患者中，ES 在数字上优于假手术。然而，这些基于类型的亚组之间没有明显的亚组差异（P = .18，I2 = 43.2%）。结论ES不能改善总体胆道SOD相关疼痛，也不能改善II型与III型SOD或正常与异常SOM亚组的疼痛。这项荟萃分析证实，SOM 或 ES 在控制 SOD 方面没有公认的作用。

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引用次数: 0

Preface: Optimizing and Sustaining High-Quality Colorectal Cancer Screening 前言优化和维持高质量的大肠癌筛查

IF 2.4 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.03.002

Audrey H. Calderwood

引用次数: 0

Outside the Training Paradigm: Challenges and Solutions for Endoscopy Provision in Resource-Limited Settings 超越培训范式：在资源有限的环境中提供内窥镜检查服务的挑战与解决方案

IF 1.2 Q4 GASTROENTEROLOGY & HEPATOLOGY

Techniques and Innovations in Gastrointestinal Endoscopy

Pub Date : 2024-01-01 DOI: 10.1016/j.tige.2024.06.002

Sandie Thomson , Chris Hair , Ganiyat Kikelomo Oyeleke

Limited-resource settings pose problems for the provision of health services. Experience with the challenges of the provision of endoscopy services and potential solutions are presented by authors who have taught and practiced in such settings in Africa and the Pacific Islands. The concept of limited-resource settings is defined in the context of health services in general. The situation regarding endoscopy provision details and discusses the unique challenges of manpower, endoscopy facilities, endoscope and accessory equipment inventory, and endoscopy reporting. Health services quality is related to wealth and how it is deployed. Simplistically wealth means health, and poverty illness. Low-income and Low middle–income countries have the biggest challenges. One is the health professional workforce. The number of gastroenterologists per 100,000 in South Africa, an upper middle–income country, is 0.33 compared with 3.9 in the United States. Hence, endoscopy provision is by general surgeons and physicians. Upper and lower gastrointestinal endoscopic capacity in East Africa was 106 and 45 procedures per 100,000 persons per year, respectively which is <10% of that reported from high-income countries. Outside major teaching hospitals, most endoscopy is practiced in uncustomized single rooms often in a surgery complex. Endoscope inventory is more expensive than in the United States as is maintenance and repair as they are out of the country resulting in many units being below the minimum requirements to run a sustained service. Electronic reporting systems are few and not standardized. The World Gastroenterology Organisation and the World Endoscopy Organization should be the overarching advocates to support public–private partnerships and develop solutions for sustainable inventory acquisition. Endoscopy must be monitored electronically to assess procedural competency and provide desperately needed information to influence health policy.

资源有限的环境给医疗服务的提供带来了问题。作者曾在非洲和太平洋岛屿的此类环境中执教和实践，他们介绍了提供内窥镜服务所面临挑战的经验和可能的解决方案。在一般医疗服务的背景下定义了资源有限环境的概念。详细介绍了内窥镜检查的提供情况，并讨论了人力、内窥镜检查设施、内窥镜和附件设备库存以及内窥镜检查报告等方面的独特挑战。医疗服务的质量与财富及其使用方式有关。简单地说，富裕意味着健康，贫穷意味着疾病。低收入和中低收入国家面临的挑战最大。其一是卫生专业人员队伍。在中上收入国家南非，每 10 万人中只有 0.33 名肠胃病学专家，而美国则有 3.9 名。因此，内窥镜检查由普通外科医生和内科医生提供。东非的上消化道内窥镜检查能力分别为每年每 10 万人 106 例和 45 例，是高收入国家的 10%。在大型教学医院之外，大多数内窥镜手术都是在非定制的单间里进行的，通常是在外科综合大楼里。内窥镜库存比美国昂贵，维护和修理也比美国昂贵，因为它们都在国外，导致许多单位的内窥镜库存低于持续提供服务所需的最低要求。电子报告系统很少，而且没有标准化。世界胃肠病学组织和世界内镜组织应成为支持公私合作伙伴关系的主要倡导者，并为可持续的库存采购制定解决方案。必须对内镜检查进行电子监控，以评估手术能力，并提供急需的信息来影响卫生政策。

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引用次数: 0