Therapeutic Advances in Gastrointestinal Endoscopy最新文献

Background: Lumen apposing metal stents (LAMSs) have a higher clinical success rate for managing pancreatic fluid collections. But they are associated with adverse events (AEs) like bleeding, migration, buried stent, occlusion, and infection. It has been hypothesized that placing a double pigtail stent (DPS) within LAMS may mitigate these AEs. The present systematic review and meta-analysis were conducted to compare the outcome and AEs associated with LAMS with or without a coaxial DPS (LAMS-DPS).

Methods: A comprehensive literature search of three databases from January 2010 to August 2022 was conducted for studies comparing the outcome and AEs of LAMS alone and LAMS-DPS. Pooled incidence and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for all the dichotomous outcomes.

Results: Overall, eight studies (n = 460) were included in the final analysis. The clinical success rate (RR 1.00, 95% CI: 0.87-1.14) and the risk of overall AEs (RR 1.60, 95% CI: 0.95-2.68) remained comparable between both groups. There was no difference in the risk of bleeding between LAMS alone and LAMS-DPS (RR 1.80, 95% CI: 0.83-3.88). Individual analysis of other AEs, including infection, stent migration, occlusion, and reintervention, showed no difference in the risk between both procedures.

Conclusion: The present meta-analysis shows that coaxial DPS within LAMS may not reduce AE rates or improve clinical outcomes. Further larger studies, including patients with walled-off necrosis, are required to demonstrate the benefit of coaxial DPS within LAMS.

Background and aims: Acute calculous cholecystitis (ACC) represents about one-third of all surgical emergencies. The gold standard management of ACC is laparoscopic cholecystectomy. Although cholecystectomy is a safe procedure, it may be dangerous and contraindicated in patients with complex comorbidities. Endoscopic transpapillary gallbladder stenting (ETGBS) and drainage had been widely used to manage patients suffering from ACC with comorbidities.

Methods: We searched PubMed, SCOPUS, Web of Science, and Cochrane Library for relevant studies assessing the use of ETGBS in patients suffering from ACC with various comorbidities. Risk of bias assessment was performed using the National Institues of Health (NIH) tool. We included the following outcomes: clinical success, technical success, late complications, and pancreatitis.

Results: We included seven studies that met our inclusion criteria. We found that the pooled proportion of clinical success, technical success, late complications, and pancreatitis was [91.3%, 95% confidence interval (CI) (86.8%, 95.9%)], [92.8%, 95% CI (89%, 96.5%)], [5.4%, 95% CI (2.9%, 7.9%)], and [3.5%, 95% CI (1.2%, 5.8%)], respectively.

Conclusion: We found that an ETGBS was an effective and well-tolerated method for the treatment of cholecystitis, especially in high-risk individuals.

Introduction: The gold-standard procedure to address malignant gastric outlet obstruction (MGOO) is surgical gastrojejunostomy (SGJJ). Two endoscopic alternatives have also been proposed: the endoscopic stenting (ES) and the endoscopic ultrasound-guided gastroenterostomy (EUS-G). This study aimed to perform a thorough and strict meta-analysis to compare EUS-G with the SGJJ and ES in treating patients with MGOO.

Materials and methods: Studies comparing EUS-G to endoscopic stenting or SGJJ for patients with MGOO were considered eligible. We conducted online searches in primary databases (MEDLINE, EMBASE, Lilacs, and Central Cochrane) from inception through October 2021. The outcomes were technical and clinical success rates, serious adverse events (SAEs), reintervention due to obstruction, length of hospital stay (LOS), and time to oral intake.

Results: We found similar technical success rates between ES and EUS-G but clinical success rates favored the latter. The comparison between EUS-G and SGJJ demonstrated better technical success rates in favor of the surgical approach but similar clinical success rates. EUS-G shortens the LOS by 2.8 days compared with ES and 5.8 days compared with SGJJ. Concerning reintervention due to obstruction, we found similar rates for EUS-G and SGJJ but considerably higher rates for ES compared with EUS-G. As to AEs, we demonstrated equivalent rates comparing EUS-G and SGJJ but significantly higher ones compared with ES.

Conclusion: Despite being novel and still under refinement, the EUS-G has good safety and efficacy profiles compared with SGJJ and ES.

Background: Clinically significant serrated polyp detection rate (CSSDR) and proximal serrated polyp detection rate (PSDR) have been suggested as the potential quality benchmarks for colonoscopy (CSSDR = 7% and PSDR = 11%) in comparison to the established benchmark adenoma detection rate (ADR). Another emerging milestone is the detection rate of lateral spreading lesions (LSLs).

Objectives: This study aimed to evaluate CSSDR, PSDR, ADR, and LSL detection rates among gastrointestinal (GI) fellows performing a colonoscopy. A secondary aim was to evaluate patient factors associated with the detection rates of these lesions.

Design and methods: A retrospective review of 799 colonoscopy reports was performed. GI fellow details, demographic data, and pathology found on colonoscopy were collected. Multiple logistic regression analysis was performed to identify the factors associated with CSSDR, PSDR, ADR, and LSL detection rates. A p value < 0.05 was considered statistically significant.

Results: For our patient population, the median age was 58 years; 396 (49.8%) were male and 386 (48.6%) were African American. The 15 GI fellows ranged from first (F1), second (F2), or third (F3) year of training. We found an overall CSSDR of 4.4%, PSDR of 10.5%, ADR of 42.1%, and LSL detection rate of 3.2%. Female gender was associated with CSSDR, while only age was associated with PSDR. GI fellow level of training was associated with LSL detection rate, with the odds of detecting them expected to be four times higher in F2/F3s than F1s.

Conclusion: Although GI fellows demonstrated an above-recommended ADR and nearly reached target PSDR, they failed to achieve target CSSDR. Future studies investigating a benchmark for LSL detection rate are needed to quantify if GI fellows are detecting these lesions at adequate rates.

Background: This study aimed to analyze the landscape of publications on bariatric metabolic surgery through machine learning and help experts and scholars from various disciplines better understand bariatric metabolic surgery's hot topics and trends.

Methods: In January 2021, publications indexed in PubMed under the Medical Subject Headings (MeSH) term 'Bariatric Surgery' from 1946 to 2020 were downloaded. Python was used to extract publication dates, abstracts, and research topics from the metadata of publications for bibliometric evaluation. Descriptive statistical analysis, social network analysis (SNA), and topic modeling with latent Dirichlet allocation (LDA) were used to reveal bariatric metabolic surgery publication growth trends, landscape, and research topics.

Results: A total of 21,798 records of bariatric metabolic surgery-related literature data were collected from PubMed. The number of publications indexed to bariatric metabolic surgery had expanded rapidly. Obesity Surgery and Surgery for Obesity and Related Diseases are currently the most published journals in bariatric metabolic surgery. The bariatric metabolic surgery research mainly included five topics: bariatric surgery intervention, clinical case management, basic research, body contour, and surgical risk study.

Conclusion: Despite a rapid increase in bariatric metabolic surgery-related publications, few studies were still on quality of life, psychological status, and long-term follow-up. In addition, basic research has gradually increased, but the mechanism of bariatric metabolic surgery remains to be further studied. It is predicted that the above research fields may become potential hot topics in the future.

Background and aims: Post-endoscopic retrograde cholangiopancreatography acute pancreatitis (PAP) and post-sphincterotomy hemorrhage are known adverse events of post-endoscopic retrograde cholangiopancreatography. Various electrosurgical currents can be used for endoscopic sphincterotomy. The extent to which this influences adverse events remains unclear. We assessed the comparative safety of different electrosurgical currents, through a Bayesian network meta-analysis of published studies merging direct and indirect comparison of trials.

Methods: We performed a Bayesian random-effects network meta-analysis of randomized controlled trials that compared the safety of different electrocautery modes for endoscopic sphincterotomy.

Results: Nine studies comparing four electrocautery modes (blended cut, pure cut, endocut, and pure cut followed by blended cut) with a combined enrollment of 1615 patients were included. The pooled results of the network meta-analysis did not show a significant difference in preventing post-sphincterotomy pancreatitis when comparing electrocautery modes. However, pure cut was associated with a statistically significant increased risk of bleeding compared with endocut [relative risk = 4.30; 95% confidence interval (1.53-12.87)]. On the other hand, the pooled results of the network meta-analysis showed no significant difference in prevention of bleeding when comparing blended cut versus endocut, pure cut followed by blended cut versus endocut, pure cut followed by blended cut versus blended cut, pure cut versus blended cut, and pure cut versus pure cut followed by blended cut. The results of rank probability found that endocut was most likely to be ranked the best.

Conclusion: No electrocautery mode was superior to another with regard to preventing PAP. Endocut was superior with respect to preventing bleeding. Therefore, we suggest performing endoscopic sphincterotomy with endocut.