EUS-guided coil and glue injection versus endoscopic glue injection for gastric varices: International multicentre propensity-matched analysis

BACKGROUND

Gastric varices (GVs) are conventionally managed with endoscopic cyanoacrylate (E-CYA) glue injection. Endoscopic ultrasound (EUS)-guided therapy using combination of coils and CYA glue (EUS-CG) is a relatively recent modality. There is limited data comparing the two techniques.

METHODOLOGY

This international multicentre study included patients with GV undergoing endotherapy from two Indian and two Italian tertiary care centres. Patients undergoing EUS-CG were compared with propensity-matched E-CYA cases from a cohort of 218 patients. Procedural details such as amount of glue, number of coils used, number of sessions required for obliteration, bleeding after index procedure rates and need for re-intervention were noted.

RESULTS

Of 276 patients, 58 (male 42, 72.4%; mean age-44.3 ± 12.1 years) underwent EUS-CG and were compared with 118 propensity-matched cases of E-CYA. In the EUS-CG arm, complete obliteration at 4 weeks was noted in 54 (93.1%) cases. Compared to the E-CYA cohort, EUS-CG arm showed significantly lower number of session (1.0 vs. 1.5; p < 0.0001) requirement, lower subsequent-bleeding episodes (13.8% vs. 39.1%; p < 0.0001) and lower re-intervention (12.1% vs. 50.4%; p < 0.001) rates. On multivariable regression analysis, size of the varix (aOR-1.17; CI 1.08-1.26) and technique of therapy (aOR-14.71; CI 4.32-50.0) were significant predictors of re-bleeding. A maximum GV size >17.5 mm had a 69% predictive accuracy for need for re-intervention.

CONCLUSION

Endoscopic ultrasound-guided therapy of GV using coil and CYA glue is a safe technique with better efficacy and lower re-bleeding rates on follow-up compared to the conventional endoscopic CYA therapy.

Long-term Outcome of Peroral Endoscopic Myotomy in Esophageal Motility Disorders: A Systematic Review and Meta-analysis

BACKGROUND AND AIM

Peroral endoscopic myotomy (POEM) is an established treatment for achalasia. In this systematic review and meta-analysis, we aimed to analyze the mid and long-term outcomes of POEM in esophageal motility disorders.

METHODS

Literature search was performed in databases including PubMed, Embase, Cochrane databases, and Google scholar from January 2010 to May 2021. The primary objective of the study was the clinical success (Eckardt score ≤3 or <4) at mid-term (30 to 60 mo) and long-term (>60 mo) follow-up after POEM. Secondary objectives included post-POEM gastroesophageal reflux (GER) as evaluated by symptoms, increased esophageal acid exposure, and reflux esophagitis.

RESULTS

Seventeen studies with 3591 patients were included in the review. Subtypes of motility disorders were type I (27%), type II (54.5%), type III (10.7%), distal esophageal spasm/Jackhammer esophagus (2%), and esophagogastric junction outflow obstruction (17.5%). Pooled mean follow-up duration was 48.9 months (95% CI, 40.02-57.75). Pooled rate of clinical success at mid-term follow-up was 87% (95% CI, 81-91; I2 , 86%) and long-term was 84% (95% CI, 76-89; I2 , 47%). In nonachalasia motility disorders (esophagogastric junction outflow obstruction, distal esophageal spasm, and Jackhammer esophagus), pooled rate of clinical success was 77% (95% CI, 65-85; I2 , 0%). GER as estimated by symptoms was 23% (95% CI, 19-27; I2 , 74%), erosive esophagitis was 27% (95% CI, 18-38%; I2 , 91%), and increased esophageal acid exposure was 41% (95% CI, 30-52; I2 , 88%).

CONCLUSION

POEM is a durable treatment option in cases with achalasia. One-fourth of patients suffer from erosive GER in the long-term and success rates are lower in nonachalasia esophageal motility disorders.

Categorizing sugarcane cultivar resistance to the sugarcane aphid and yellow sugarcane aphid (Hemiptera: Aphididae)

Sugarcane (Saccharum spp.) in Louisiana is colonized by two aphid species, the sugarcane aphid, Melanaphis sacchari (Zehntner), and the yellow sugarcane aphid, Sipha flava (Forbes) (Hemiptera: Aphididae). The main problem associated with M. sacchari is transmission of sugarcane yellow leaf virus, a casual agent of yellow leaf disease whose absence has been added to certification standards for micropropagated sugarcane in Louisiana. Greenhouse studies were conducted to categorize dominant commercial sugarcane cultivars for their ability to tolerate aphid injury and to express antixenotic or antibiotic effects on both aphid species. Antixenosis tests showed no preference among cultivars by either aphid species. Loss of chlorophyll content in tolerance tests also did not show differences among cultivars for both aphid species. However, antibiosis tests revealed that life history parameters such as the duration of the reproductive period and fecundity of both aphid species were negatively affected on 'HoCP 91-555' compared with 'L 97-128'. Estimation of demographic statistics indicated that both aphid species exhibited a significantly lower intrinsic rate of increase (1.8-2.8-fold) and longer doubling time (1.7-3.1-fold) on HoCP 91-555 relative to L 97-128. From these tests, cultivars in the current study can be ranked from most to the least susceptible as L 97-128 > 'LCP 85-384' > 'HoCP 96-540' > 'Ho 95-988' > HoCP 91-555 for M. sacchari and L 97-128 > LCP 85-384 > HoCP 91-555 for S. flava. Therefore, antibiosis is an important category of resistance in sugarcane to both aphid species, and HoCP 91-555 might provide useful germplasm for developing aphid resistant cultivars.

Impact of Hurricane Rita storm surge on sugarcane borer (Lepidoptera: Crambidae) management in Louisiana

Twelve thousand to 16,000 ha of Louisiana sugarcane (Saccharum spp.) fields were flooded by saltwater from the Hurricane Rita storm surge in September 2005. A four treatment, 12-replication study comparing storm surge flooded and nonflooded plant and ratoon sugarcane fields was conducted during summer 2006 to assess sugarcane borer, Diatraea saccharalis (F.), pest severity, pest control actions, and soil-associated arthropod abundance and diversity. Even with a significant 2.4-fold increase in the average number of insecticide applications used for D. saccharalis management in flooded fields, growers still incurred higher injury. A significant 2.8-fold reduction in the predaceous red imported fire ant, Solenopsis invicta Buren, was associated with the storm surge, whereas no reduction in abundance of other soil-associated arthropods was recorded. Arthropod diversity measured by the Shannon diversity index significantly increased by a factor of 1.3 in sugarcane fields flooded by the storm surge. Increase in D. saccharalis pest severity associated with the storm surge caused an estimated loss in revenue between $1.9 and $2.6 million to the Louisiana sugarcane industry for the 2006 production season.

Selection and life history traits of tebufenozide-resistant sugarcane borer (Lepidoptera: Crambidae)

Varying susceptibility to tebufenozide was recorded in the sugarcane borer, Diatraea saccharalis (F.) (Lepidoptera: Crambidae), collected from Louisiana sugarcane locations with different selection pressures. Results from diet incorporation bioassays with tebufenozide indicated significant increases in LC50 (3.78-fold) and LC90 (7-fold) values for a colony from Duson (DU), an area with higher selection pressure, compared with a colony from Alexandria (ALEX), an area with no selection pressure. Differences were not detected in LC50 values among colonies from areas where use of tebufenozide was discontinued or rotated with other chemistries. Selections with tebufenozide of DU larvae over 12 generations resulted in a highly resistant colony (DU-R) with 27.1- and 83.3-fold increases in LC50 and LC90 values, respectively. Comparison of pupal weight, days to pupation, and emergence after exposure to an equitoxic (LC20) concentration of tebufenozide revealed a decrease in pupal weight (34 and 33% for males and females, respectively), and an increase in days to pupation (47 and 40% for males and females, respectively), and emergence (43 and 33% for males and females, respectively) for the DU-R colony compared with the parent DU colony. Fecundity of DU-R females decreased to 72 eggs per female compared with 180 (DU) and 261 (ALEX). Egg viability of the ALEX and DU colonies was 61 and 56%, respectively, whereas only 27% of eggs laid by females from the DU-R colony hatched. These results are discussed in terms of their practical implications for control of D. saccharalis in Louisiana sugarcane.

Reduced susceptibility to tebufenozide in populations of the sugarcane borer (Lepidoptera: Crambidae) in Louisiana

Susceptibility of the sugarcane borer, Diatraea saccharalis (F.), to tebufenozide was measured using a feeding bioassay, and values obtained were compared with baselines generated before the use of this insecticide in Louisiana sugarcane, Saccharum spp. Results from our study suggest that susceptibility to tebufenozide is decreasing in field-collected sugarcane borers. Inflections in the log dosage-probit lines were detected for many of the field collections, indicating increased heterogeneity within these populations in response to tebufenozide. Where appropriate, probit transformation was used to estimate susceptibility, and significant differences (1.6 - 2.7-fold) were measured in LC50 values between some field-collected cohorts and the previously measured baseline. In addition, a discriminating concentration (0.5 ppm) was used to estimate resistance frequencies in cohorts for which probit transformation was not appropriate. Results from these tests suggest that frequencies of resistance were high (49% in one cohort) in populations from some locations. Lighter weight pupae of the survivors from one of the more resistant cohorts suggests that tebufenozide resistance mechanisms may have a biological cost in terms of ecological fitness at early stages of resistance development. As a result of continued resistance monitoring, alternation of management chemistry is expected to help preserve this valuable sugarcane integrated pest management tactic.