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Gatam AR, Noor EA, Gatam L. Unilateral biportal endoscopic surgical decompression for symptomatic ossification of the ligamentum flavum - Is it enough to improve the clinical outcome? A case-control study. J Orthop 2024; 53:150-155. [PMID: 38601893 PMCID: PMC11001628 DOI: 10.1016/j.jor.2024.03.037] [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: 03/19/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024] Open
Abstract
Purpose Open decompression is currently the standard surgical procedure for symptomatic OLF. As the minimal invasive method gains popularity, UBE is considered a reliable technique with less complication. However, the outcome is still in question. This study aimed to evaluate and compare UBE versus open surgery in symptomatic OLF cases. Methods We evaluated 35 patients with single- or two-level thoracic OLF, underwent decompression by open or UBE. Surgery duration, estimated blood loss, and LOS were recorded as intraoperative parameters. Minimum follow-up was 1 year to evaluate clinical parameters based on the mJOA score, Frankel grade, and recovery rate (RR). Results The UBE procedure showed significant superiority with faster surgery (62.5 min vs. 180 min; p < 0.001), less blood loss (50 mL vs. 250 mL; p < 0.001), and shorter LOS (4 days vs. 6 days; p < 0,001). UBE patients showed notable clinical improvement on the mJOA score at 1 year (8.2 ± 0.18 vs. 6.8 ± 0.24; p = 0.015). Frankel grade improvements seen in both groups with 51.4% of subjects having at least a 1-point upgrade. RR in 1 year resulted in significant recovery in UBE group (RR-UBE 43.2 ± 17 vs. RR-open 26.3 ± 15.3; p < 0.05). No neurological deterioration or significant complication occurred after either procedure. Conclusion The UBE technique allows faster decompression with less blood loss and shorter LOS compared to open surgery. It was found to be a reliable treatment option in treating OLF with favorable clinical outcomes and improved patient neurological status.
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Affiliation(s)
- Asrafi Rizki Gatam
- Orthopedic Spine, Gatam Institute – Eka Hospital BSD, Banten, Indonesia
- Orthopedic Spine Division, Fatmawati General Hospital, Jakarta, Indonesia
| | - Erwin Ardian Noor
- Orthopedic Spine Division, Fatmawati General Hospital, Jakarta, Indonesia
| | - Luthfi Gatam
- Orthopedic Spine, Gatam Institute – Eka Hospital BSD, Banten, Indonesia
- Faculty of Medicine, Universitas Lambung Mangkurat, Banjarmasin, Indonesia
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2
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Fatahajjad HH, Ompusunggu RA, Laksita TB, Soebadi MA. Multiple lower urinary tract calculi induced by foreign bodies insertion: A case report. Radiol Case Rep 2024; 19:2443-2447. [PMID: 38585402 PMCID: PMC10997869 DOI: 10.1016/j.radcr.2024.02.100] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 04/09/2024] Open
Abstract
Lower urinary tract foreign bodies are often reported but the underlying causes remain intriguing, ranging from unconventional practices to medical interventions. This condition predominantly affects young males and presentations are varied from asymptomatic, lower urinary tract symptoms to acute obstructive renal failure. We report a case of a 48-year-old male presented with lower urinary tract symptoms and obstructive renal failure. Imaging revealed multiple foreign bodies in the pelvic cavity, suggestive of vesical, and urethral lithiasis. Urethrocystoscopy removed an 8-cm needle with rubber band and a 10-cm encrusted cable, forming a urethral stone. Vesicolithotomy removed a 5 × 3 cm bladder stone with a SIM card inserter as its core. The patient's condition improved after surgery. Notably, the patient's history prompted a psychiatric evaluation, leading to the diagnosis of and treatment for an adjustment disorder. While endourology procedure is effective in most cases, some cases necessitate open surgery. Identification and treatment of underlying psychiatric disorders is needed to for long term care.
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Affiliation(s)
- Haykal Hermatyar Fatahajjad
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Ricky Agave Ompusunggu
- Department of Urology, Abdoel Wahab Sjahranie Hospital, Samarinda, East Kalimantan, Indonesia
| | - Tetuka Bagus Laksita
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia
| | - Mohammad Ayodhia Soebadi
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Universitas Airlangga Teaching Hospital, Surabaya, East Java, Indonesia
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Lykkegaard J, Olsen JK, Wehberg S, Jarbøl DE. The durability of previous examinations for cancer: Danish nationwide cohort study. Scand J Prim Health Care 2024; 42:246-253. [PMID: 38251839 PMCID: PMC11003324 DOI: 10.1080/02813432.2024.2305942] [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: 08/11/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVE Patients previously examined for cancer with a negative result may present in general practice with ongoing or new symptoms or signs suggestive of cancer. This paper explores the potential existence of a relatively safe period for cancer occurrence after receiving negative examination results for specific types of cancer, including lung (CT thorax), upper gastrointestinal (gastroscopy), colorectal (colonoscopy), bladder (cystoscopy), and breast (clinical mammography). DESIGN Register-based time-to-event analyses. SETTING Denmark. SUBJECTS All 3.3 million citizens aged 30-85 years who on January first, 2017, had not previously been diagnosed with the specific type of cancer were categorized based on the time since their most recent examination. MAIN OUTCOME MEASURES Using 1-year follow-up, we calculated the age- and sex-adjusted hazard ratios of being diagnosed with the related cancer, with non-examined individuals as reference. Negative examination results were defined as the absence of a cancer diagnosis within 6 months following the examination. RESULTS Previous negative examination results were common, also among those diagnosed with cancer during follow-up. For 10 years after a negative colonoscopy the risk of diagnosing a colorectal cancer was nearly halved. However, already 1 year after a clinical mammography and 2 years after a CT thorax the risk of diagnosing the related cancers was significantly higher among those with a previous negative result compared to non-examined individuals. CONCLUSION This study did not identify a post-examination period in which the cancer risk, compared to non-examined individuals, was sufficiently low to confidently rule out any of the investigated cancers.
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Affiliation(s)
- Jesper Lykkegaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jonas Kanstrup Olsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Graillon N, Marty P, Foletti JM, Chossegros C, Frandjian H. Idiopathic dilatation of the submandibular gland duct. Int J Oral Maxillofac Surg 2024; 53:389-392. [PMID: 37845088 DOI: 10.1016/j.ijom.2023.09.011] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
Lithiasis and stenosis may cause salivary duct dilatation due to the increased pressure in the duct upstream of the obstruction. Idiopathic dilatations, also called megaducts, with no associated increase in pressure, have only been described in the parotid gland. The aim of this study was to describe the characteristics of submandibular duct dilatation unrelated to lithiasis, stenosis, or an imperforate duct, to report the existence of submandibular megaducts. This retrospective single-centre study included patients treated at La Conception University Hospital, Marseille, France, between 2007 and 2019. Patients with submandibular duct dilatation of ≥4 mm confirmed by magnetic resonance imaging sialography (sialo-MRI), who also underwent sialendoscopy to identify any associated stenosis, were included. Patients with lithiasis, stenosis, an imperforate ostium, or a history of trauma or surgery to the floor of the mouth were excluded. Five patients (three female, two male) aged 30-76 years with idiopathic duct dilatations in nine submandibular glands were included. The most commonly reported symptoms were submandibular swelling, pruritus, and discomfort, mostly outside mealtimes. Recurrence of symptoms after treatment was frequent. This study is novel in describing submandibular megaducts as opposed to dilatation caused by high pressure associated with stenosis, with confirmation by sialo-MRI and sialendoscopy.
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Affiliation(s)
- N Graillon
- Department of Oral and Maxillofacial Surgery, APHM, Conception University Hospital, Marseille, France; Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, Marseille, France.
| | - P Marty
- Department of Oral and Maxillofacial Surgery, Clinique Saint Pierre d'Ottignies, Ottignies-Louvain la Neuve, Belgium
| | - J-M Foletti
- Department of Oral and Maxillofacial Surgery, APHM, Conception University Hospital, Marseille, France; Laboratoire de Bioméchanique Appliquée (LBA), Gustave Eiffel University/Aix-Marseille University, Marseille, France
| | - C Chossegros
- Department of Oral and Maxillofacial Surgery, APHM, Conception University Hospital, Marseille, France
| | - H Frandjian
- Department of Oral and Maxillofacial Surgery, APHM, Conception University Hospital, Marseille, France
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Zhao YN, Zheng DN, Qu LY, Xie XY, Liu DG, Yu GY. Removal of intraglandular calculi in Wharton's duct: clinical outcome and treatment algorithm. Int J Oral Maxillofac Surg 2024; 53:382-388. [PMID: 38092608 DOI: 10.1016/j.ijom.2023.12.001] [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] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/06/2023] [Accepted: 12/01/2023] [Indexed: 04/16/2024]
Abstract
The aim of this study was to propose a treatment strategy for intraglandular submandibular calculi based on calculus site. Seventy-three consecutive patients with impalpable intraglandular submandibular calculi were enrolled retrospectively. The calculi were classified as either post-hilar type, central type, or superficial type. Treatment approaches included transoral duct slitting (TDS), interventional basket retrieval (IBR), intraductal laser lithotripsy (ILL), and transcervical lithotomy (TCL). Complete calculus removal with gland preservation was achieved in 64 patients (87.7%). The success rate for post-hilar, central, and superficial calculi was 86.4% (51/59), 90.9% (10/11), and 100% (3/3), respectively. The treatment approach applied in patients with treatment success was TDS in 32 cases, IBR in 20, ILL in nine, and TCL in three. During follow-up (median 17.3 months), one patient experienced gland atrophy and three had ductal stenosis; the remaining 60 patients (93.8%, 60/64) had good clinical outcomes. In the eight failure cases operated by TDS, the deeply situated calculi could not be detached despite the parenchymal incision in five cases, while the procedure was ceased due to the patient's inability to cooperate in the other three cases. In the remaining failure case, the submandibular gland was sacrificed after calculus extraction via TCL. Application of the proposed treatment algorithm might help preserve gland function in patients with intraglandular submandibular calculi.
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Affiliation(s)
- Y-N Zhao
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
| | - D-N Zheng
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
| | - L-Y Qu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
| | - X-Y Xie
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
| | - D-G Liu
- Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China.
| | - G-Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Haidian District, Beijing, PR China
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Richetta C, Shiran SI, Constantini S, Roth J. The prepontine block and its relevance for the development and treatment of hydrocephalus. Childs Nerv Syst 2024; 40:1577-1581. [PMID: 38376529 PMCID: PMC11026192 DOI: 10.1007/s00381-024-06323-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE Pulsatile CSF flow patterns include flow through the ventricles to the subarachnoid space and cisterns and from the infra- to the supratentorial subarachnoid space. In this study, we demonstrate how an obstruction at the level of the prepontine space may lead to obstructive hydrocephalus with specific radiological characteristics, as well as the implications for treatment options. METHODS We retrospectively collected data of patients who underwent surgery between February 2010 and December 2022 for hydrocephalus secondary to a suspected prepontine block. One additional patient diagnosed with prepontine block who did not undergo surgery was also included. We excluded patients with a background of previous unrelated neurosurgical procedures or CNS infections. RESULTS Six children and two adults were included. Three presented with hydrocephalus on imaging, without any other underlying pathology. Five had a suprasellar arachnoid cyst, with its lower border abating the pons and occluding the spinal subarachnoid space (SAS). All cases had an open aqueduct on T2 sagittal sequences, as well as an infracerebellar or retrocerebellar CSF collection. In most cases, a horizontal web was identified in the prepontine region. Seven cases were treated with an endoscopic fenestration. One patient subsequently underwent a shunt surgery. All the operated children reached normal developmental milestones after surgery. CONCLUSIONS This paper describes a rather small series of cases where clear obstruction was observed at the level of the prepontine subarachnoid space. We believe this anatomical subtlety adds to a better understanding of CSF pathways and the role of ETV in treating hydrocephalus, focusing on a small subgroup of patients without a clear obstruction.
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Affiliation(s)
- Carla Richetta
- Departments of Pediatric Neurosurgery and the Pediatric Brain Center, Dana Children's Hospital, Tel Aviv Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel
| | - Shelly I Shiran
- Pediatric Radiology Unit, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shlomi Constantini
- Departments of Pediatric Neurosurgery and the Pediatric Brain Center, Dana Children's Hospital, Tel Aviv Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jonathan Roth
- Departments of Pediatric Neurosurgery and the Pediatric Brain Center, Dana Children's Hospital, Tel Aviv Medical Center, 6 Weizman Street, Tel Aviv, 64239, Israel.
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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7
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Dorji T, Wangmo S, Dargay S, Dorji N, Dorjey Y, Pradhan B, Pema D, Dema C, Choden J, Dorji T, Mynak ML, Pempa, Jamphel K. Population-level cancer screening and cancer care in Bhutan, 2020-2023: a review. Lancet Reg Health Southeast Asia 2024; 24:100370. [PMID: 38444883 PMCID: PMC10910341 DOI: 10.1016/j.lansea.2024.100370] [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] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
Screening of cancers is an important intervention in reducing the incidence and mortality related to cancers. Bhutan is one small country that is witnessing an increasing incidence and mortality related to cancers. The government implemented a time-bound population-level screening for gastric, cervical and breast cancers from 2020 to 2023 with an overall coverage of 91.2% of the eligible population. Among 370,225 individuals screened for H pylori, 32.4% tested positive; among 53,182 who underwent upper gastrointestinal endoscopy and biopsy, 255 (0.07%) had gastric cancer. Among 10,749 tested for HPV DNA, 9.3% were positive; among 9887 evaluated with colposcopy and biopsy, 154 (0.13%) had cervical cancer. For breast cancer screening, 72,283 underwent clinical breast examination, 845 mammography and cancer was detected in 73 (0.10%) individuals. In this article, we review how Bhutan implemented a population-level cancer screening programme with on boarding of multiple stakeholders and the participation of people across all districts.
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Affiliation(s)
- Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sangay Wangmo
- Department of Surgery, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Sonam Dargay
- Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Namkha Dorji
- Department of Obstetrics and Gynaecology, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Yeshey Dorjey
- Department of Obstetrics and Gynaecology, Phuentsholing General Hospital, Phuentsholing, Bhutan
| | - Birendra Pradhan
- Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Dechen Pema
- Department of Radiodiagnosis and Imaging, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Choney Dema
- National Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Jamyang Choden
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
| | | | | | - Pempa
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
| | - Kinga Jamphel
- Department of Health Services, Ministry of Health, Thimphu, Bhutan
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8
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Goodman MC, Chang P, Minteer W, Nguyen D, Gopalkrishnan K, Phan J. Patient Complications and Device Issues Associated With FDA-Approved Intragastric Balloons Available in the USA: A Maude Database Study. Obes Surg 2024; 34:1971-1974. [PMID: 38467899 PMCID: PMC11031455 DOI: 10.1007/s11695-024-07128-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Morgan C Goodman
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Patrick Chang
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - William Minteer
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Denis Nguyen
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Kalpana Gopalkrishnan
- Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Jennifer Phan
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Owen CK, Felinski MM, Bajwa KS, Walker PA, Mehta SS, Wilson EB, Boodoo S, Kudav V, Akhtar SJ, Shah SK, Kling ME. Frequency of Clinically Significant Findings in the Surgical Pathology Specimen Following Laparoscopic Sleeve Gastrectomy and Concordance with Preoperative Endoscopy: Insights from a Large Single-Center Experience. Obes Surg 2024; 34:1442-1448. [PMID: 38472705 DOI: 10.1007/s11695-024-07155-y] [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] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Endoscopy prior to bariatric surgery is not always performed, and in sleeve gastrectomy (SG), the surgical specimen is not always sent for pathological examination. There is limited data on the frequency of clinically significant findings in SG specimens or correlation with preoperative endoscopy. METHODS We reviewed 426 consecutive SG patients to determine the concordance of preoperative endoscopy findings in patients with clinically significant postoperative pathology. RESULTS Preoperative endoscopy was performed on 397 patients (93.2%). Three hundred seventy-three patients had preoperative endoscopy and surgical pathology results available. Then, 20/373 (5.4%) patients had potentially significant postoperative pathology, including intestinal metaplasia, autoimmune metaplastic atrophic gastritis (AMAG), gastrointestinal stromal tumors, and/or gastric cancer. The overall incidence of AMAG in the entire cohort was 2.3%. Preoperative gastric biopsies (to include gastric body) identified AMAG in nearly 1/2 of patients. Patients with clinically significant postoperative pathology results had a median [interquartile range] of 3 [3-5] tissue blocks examined as compared to 3 [1-3] for the remainder of the cohort (p < 0.001). CONCLUSION This is one of the largest studies describing clinically significant postoperative pathology after SG. AMAG, in particular, is of particular importance as it is associated with a 3-fivefold increase in risk for gastric cancer. The incidence of significant postoperative pathology in this population is small but potentially clinically significant and requires validation in larger studies. We recommend wider sampling in preoperative endoscopy (body and antrum), especially in patients being planned for gastric bypass, consideration for routine pathological examination of SG surgical specimens, with careful gross examination and targeted sampling.
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Affiliation(s)
- Christopher K Owen
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Melissa M Felinski
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kulvinder S Bajwa
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Peter A Walker
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Erik B Wilson
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Vishal Kudav
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shaan J Akhtar
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shinil K Shah
- Division of Minimally Invasive and Elective General Surgery, Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Michael E DeBakey Institute of Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA.
| | - M Elaine Kling
- Brown and Associates Medical Laboratories, Sugar Land, TX, USA
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10
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Fontana V, Sinosi FA, Marchioni D, Masotto B. Transcanal transpromontorial approach for vestibular schwannoma: experience of a single center. Eur Arch Otorhinolaryngol 2024; 281:2679-2690. [PMID: 38519593 DOI: 10.1007/s00405-024-08565-5] [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] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/16/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The expanded transpromontorial transcanal approach (ExpTTA) represents a recent addition to the surgical approaches available for the treatment of vestibular schwannoma. An initial purely endoscopic version has been complemented by the use of the microscope and it is now one of the possible surgical options for small to medium-sized vestibular schwannomas with a predominantly intracanalar development. METHODS This is a series of 54 patients who underwent microsurgical resection of sporadic, unilateral vestibular schwannoma, mainly Koos I-II with non-serviceable hearing, between January 2016 and January 2023 using the expanded transcanal transpromontorial approach. We describe the surgical technique, focusing on anatomical landmarks, and analyzing its advantages and shortcomings. Retrospective analysis of clinical outcomes is presented, including early and late complications. The mean follow-up was 46.7 months. RESULTS We achieved gross total resection of the lesion in all cases, confirmed on the first follow-up MRI at least 6 months after each procedure. We did not record any intraoperative complication nor disease recurrence. We recorded two postoperative severe facial nerve palsies, one of which was permanent. No cases of disabling vertigo or imbalance were reported, and all patients reported full recovery of autonomy in daily activities. Three cases of otoliquorrhea were managed conservatively successfully. CONCLUSIONS The transcanal transpromontorial approach combines the advantages of endoscopy with the possibilities provided by microsurgery. Our experience confirms its safety in terms of surgical complications and facial nerve outcome. This approach is amongst the treatment options for small-medium schwannomas in patients with impaired hearing, especially in young patients, ensuring radical resection, disease control, and minimal morbidity.
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Affiliation(s)
- Vincenzo Fontana
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy.
| | - F A Sinosi
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy, Ospedale Civile Maggiore Verona, Verona, Italy
| | - D Marchioni
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy
| | - B Masotto
- Posterior Cranial Fossa Unit, Department of Neurosciences, Biomedicine and Movement Sciences, Ospedale Civile Maggiore Verona, Verona, Italy
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11
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Rafaqat W, Lagazzi E, McChesney S, Smith MC, UrRahman M, Lee H, DeWane MP, Khan A. To Resect or Not to Resect: A Nationwide Comparison of Management of Sigmoid Volvulus. J Surg Res 2024; 297:101-108. [PMID: 38484451 DOI: 10.1016/j.jss.2023.12.054] [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] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/29/2023] [Accepted: 12/24/2023] [Indexed: 04/19/2024]
Abstract
INTRODUCTION Despite the high recurrence rate of sigmoid volvulus, there is reluctance to perform a prophylactic colectomy in frail patients due to the operation's perceived risks. We used a nationally representative database to compare risk of recurrence in patients undergoing a prophylactic colectomy versus endoscopic detorsion alone. METHODS We performed a retrospective cohort study using the National Readmission Database (2016-2019) including patients aged ≥18 y who had an emergent admission for sigmoid volvulus and underwent endoscopic detorsion on the day of admission. We performed a 1:1 propensity matching adjusting for patient demographics, frailty score comprising of 109 components, and hospital characteristics. Our primary outcome was readmission due to colonic volvulus and secondary outcomes included mortality, complications, length of stay (LOS), and costs during index admission and readmission. We performed a subgroup analysis in patients with Hospital Frailty Score >5. RESULTS We included 2113 patients of which 1046 patients (49.5%) underwent a colectomy during the initial admission. In the matched population of 830 pairs, readmission due to colonic volvulus was significantly lower in patients undergoing endoscopy followed by colectomy than endoscopy alone. Patients undergoing a colectomy had higher gastric and renal complications, longer LOS, and higher costs but no difference in mortality. In the subgroup analysis of frail patients, readmission was significantly lower in patients with prophylactic colectomy with no significant difference in mortality in 439 matched patients. CONCLUSIONS Prophylactic colectomy was associated with lower readmission, a higher rate of complications, increased LOS, and higher costs compared to sigmoid decompression alone.
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Affiliation(s)
- Wardah Rafaqat
- Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emanuele Lagazzi
- Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shannon McChesney
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Michael C Smith
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mujeeb UrRahman
- Department of Surgery, District Headquarters Hospital, Buner, Pakistan
| | - Hanjoo Lee
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, California
| | - Michael P DeWane
- Division of Trauma, Emergency General Surgery, and Surgical Critical care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Aimal Khan
- Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
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12
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Greuter T, Katzka D. Endoscopic Features of Eosinophilic Gastrointestinal Diseases. Immunol Allergy Clin North Am 2024; 44:357-368. [PMID: 38575229 DOI: 10.1016/j.iac.2024.01.007] [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] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Endoscopic evaluation with biopsies is a mainstay of the diagnosis of eosinophilic esophagitis (EoE) and non-EoE eosinophilic gastrointestinal diseases (EGIDs). Increasing knowledge has resulted in the development of 2 standardized scoring systems: the Endoscopic REFerence Score (EREFS) for EoE and the EG-REFS for eosinophilic gastritis, although the latter has not been validated. In EGIDs, diagnosis and follow-up focus on eosinophil infiltration in biopsies. In this article, we will discuss the most commonly used endoscopic scores in EoE and non-EoE EGIDs, their validity for the diagnosis and follow-up of disease activity, as well as endoscopic interventions and areas of uncertainty.
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Affiliation(s)
- Thomas Greuter
- Division of Gastroenterology and Hepatology, University Hospital Lausanne - CHUV, Lausanne Switzerland; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Department of Internal Medicine, GZO - Zurich Regional Health Center, Spitalstrassse 66, Wetzikon 8610, Switzerland.
| | - David Katzka
- Division of Digestive and Liver Diseases, Presbyterian Hospital, 622 West 168th Street, New York, NY 10032, USA
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13
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Jaspers TJM, Boers TGW, Kusters CHJ, Jong MR, Jukema JB, de Groof AJ, Bergman JJ, de With PHN, van der Sommen F. Robustness evaluation of deep neural networks for endoscopic image analysis: Insights and strategies. Med Image Anal 2024; 94:103157. [PMID: 38574544 DOI: 10.1016/j.media.2024.103157] [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] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
Computer-aided detection and diagnosis systems (CADe/CADx) in endoscopy are commonly trained using high-quality imagery, which is not representative for the heterogeneous input typically encountered in clinical practice. In endoscopy, the image quality heavily relies on both the skills and experience of the endoscopist and the specifications of the system used for screening. Factors such as poor illumination, motion blur, and specific post-processing settings can significantly alter the quality and general appearance of these images. This so-called domain gap between the data used for developing the system and the data it encounters after deployment, and the impact it has on the performance of deep neural networks (DNNs) supportive endoscopic CAD systems remains largely unexplored. As many of such systems, for e.g. polyp detection, are already being rolled out in clinical practice, this poses severe patient risks in particularly community hospitals, where both the imaging equipment and experience are subject to considerable variation. Therefore, this study aims to evaluate the impact of this domain gap on the clinical performance of CADe/CADx for various endoscopic applications. For this, we leverage two publicly available data sets (KVASIR-SEG and GIANA) and two in-house data sets. We investigate the performance of commonly-used DNN architectures under synthetic, clinically calibrated image degradations and on a prospectively collected dataset including 342 endoscopic images of lower subjective quality. Additionally, we assess the influence of DNN architecture and complexity, data augmentation, and pretraining techniques for improved robustness. The results reveal a considerable decline in performance of 11.6% (±1.5) as compared to the reference, within the clinically calibrated boundaries of image degradations. Nevertheless, employing more advanced DNN architectures and self-supervised in-domain pre-training effectively mitigate this drop to 7.7% (±2.03). Additionally, these enhancements yield the highest performance on the manually collected test set including images with lower subjective quality. By comprehensively assessing the robustness of popular DNN architectures and training strategies across multiple datasets, this study provides valuable insights into their performance and limitations for endoscopic applications. The findings highlight the importance of including robustness evaluation when developing DNNs for endoscopy applications and propose strategies to mitigate performance loss.
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Affiliation(s)
- Tim J M Jaspers
- Department of Electrical Engineering, Video Coding & Architectures, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Tim G W Boers
- Department of Electrical Engineering, Video Coding & Architectures, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Carolus H J Kusters
- Department of Electrical Engineering, Video Coding & Architectures, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Martijn R Jong
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jelmer B Jukema
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Albert J de Groof
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jacques J Bergman
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter H N de With
- Department of Electrical Engineering, Video Coding & Architectures, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Fons van der Sommen
- Department of Electrical Engineering, Video Coding & Architectures, Eindhoven University of Technology, Eindhoven, The Netherlands
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14
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Espinel Y, Rabbani N, Bui TB, Ribeiro M, Buc E, Bartoli A. Keyhole-aware laparoscopic augmented reality. Med Image Anal 2024; 94:103161. [PMID: 38574543 DOI: 10.1016/j.media.2024.103161] [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] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Augmented Reality (AR) from preoperative data is a promising approach to improve intraoperative tumour localisation in Laparoscopic Liver Resection (LLR). Existing systems register the preoperative tumour model with the laparoscopic images and render it by direct camera projection, as if the organ were transparent. However, a simple geometric reasoning shows that this may induce serious surgeon misguidance. This is because the tools enter in a different keyhole than the laparoscope. As AR is particularly important for deep tumours, this problem potentially hinders the whole interest of AR guidance. A remedy to this issue is to project the tumour from its internal position to the liver surface towards the tool keyhole, and only then to the camera. This raises the problem of estimating the tool keyhole position in laparoscope coordinates. We propose a keyhole-aware pipeline which resolves the problem by using the observed tool to probe the keyhole position and by showing a keyhole-aware visualisation of the tumour. We assess the benefits of our pipeline quantitatively on a geometric in silico model and on a liver phantom model, as well as qualitatively on three patient data.
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Affiliation(s)
- Yamid Espinel
- Université Clermont Auvergne, 28 place Henri Dunant, 63000 Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Navid Rabbani
- Université Clermont Auvergne, 28 place Henri Dunant, 63000 Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Thien Bao Bui
- SURGAR Surgery, 22 allée Alan Turing, 63000 Clermont-Ferrand, France.
| | - Mathieu Ribeiro
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Emmanuel Buc
- Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
| | - Adrien Bartoli
- Université Clermont Auvergne, 28 place Henri Dunant, 63000 Clermont-Ferrand, France; Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, 63000 Clermont-Ferrand, France.
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15
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Kral J, Benes M, Lanska V, Macinga P, Drastich P, Spicak J, Hucl T. Long-term Results of Duodeno-jejunal Bypass in the Treatment of Obesity and Type 2 Diabetes. Obes Surg 2024; 34:1407-1414. [PMID: 38436919 PMCID: PMC11031453 DOI: 10.1007/s11695-023-06979-4] [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] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 03/05/2024]
Abstract
PURPOSE Obesity and its related severe comorbidities are increasing rapidly. The duodenal-jejunal bypass is an endoscopically implanted device (mimicking the Roux-en-Y gastric bypass) developed to support weight reduction and improve type 2 diabetes control. MATERIALS AND METHODS Retrospective data analysis of consecutive patients undergoing duodenal-jejunal bypass (EndoBarrier®, DJB) implantation between 2013 and 2017 was performed to evaluate safety as well as short- and long-term efficacy. RESULTS One hundred and twenty-one patients (mean BMI of 43.1 ± 7.2 kg/m2 and weight of 138.2 ± 28.6 kg) underwent DJB implantation. The mean dwelling time was 15.5 months, the mean total body weight loss (%TBWL) after explantation was 10.3% ± 7.9% (14.2 kg, p < 0.0001), and the mean BMI was 39.5 ± 7.3 kg/m2 (p < 0.0001). There was no significant weight gain 24 months after the explantation. Seventy-seven patients had type 2 diabetes mellitus (T2DM) with a mean HbA1c before implantation of 5.6% (n = 52). The mean HbA1c after explantation was 5.1% (p = 0.0001). Significant reductions in transaminase and lipid levels before and after explantation were observed. One complication occurred during implantation and another during explantation. In 16 patients, the device had to be extracted earlier than expected (7 for severe adverse events and 9 for adverse events; 13.2%). CONCLUSION Despite an evident rate of adverse events, the DJB shows promise as a weight-loss procedure. Our results show that some patients implanted with the device maintained reduced weight even 24 months after explantation, while many improved T2DM control.
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Affiliation(s)
- Jan Kral
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21, Prague, Czech Republic.
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Marek Benes
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21, Prague, Czech Republic
| | - Vera Lanska
- Department of Statistics, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21, Prague, Czech Republic
| | - Peter Macinga
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21, Prague, Czech Republic
| | - Pavel Drastich
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21, Prague, Czech Republic
| | - Julius Spicak
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21, Prague, Czech Republic
| | - Tomas Hucl
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, 140 21, Prague, Czech Republic
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16
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Covantsev S. New frontiers in ectopic pancreatic tissue management. World J Gastrointest Surg 2024; 16:1215-1217. [DOI: 10.4240/wjgs.v16.i4.1215] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/28/2024] [Accepted: 03/26/2024] [Indexed: 04/22/2024] Open
Abstract
The pancreatic development variations are relatively frequent but are often overlooked in clinical practice. This is due to the fact that they do not present with a distinct clinical picture and are usually asymptomatic. It also refers to the ectopic pancreatic tissue in the stomach. This anomaly can be diagnosed in any part of the digestive system, but it is mostly seen in the upper gastrointestinal tract, especially in the stomach, duodenum and jejunum. The management of this condition has evolved due to the development of minimally invasive procedures.
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Affiliation(s)
- Serghei Covantsev
- Department of Clinical Research and Development, Botkin Hospital, Moscow 125284, Russia
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17
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Pan S, Li Y, Chen Z. A large asymptomatic rectal tonsil. Asian J Surg 2024:S1015-9584(24)00734-6. [PMID: 38658279 DOI: 10.1016/j.asjsur.2024.04.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Shaorong Pan
- Department of Gastrointestinal Surgery, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing, 100034, PR China
| | - Yalun Li
- Department of Gastrointestinal Surgery, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing, 100034, PR China
| | - Zeyang Chen
- Department of Gastrointestinal Surgery, Peking University First Hospital, Peking University, 8 Xi ShiKu Street, Beijing, 100034, PR China.
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18
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Ridha B, Hey N, Ritchie L, Toews R, Turcotte Z, Jamison B. Predicting the need for urgent endoscopic intervention in lower gastrointestinal bleeding: a retrospective review. BMC Emerg Med 2024; 24:71. [PMID: 38654175 DOI: 10.1186/s12873-024-00990-3] [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] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Lower gastrointestinal bleeding (LGIB) is a common reason for emergency department visits and subsequent hospitalizations. Recent data suggests that low-risk patients may be safely evaluated as an outpatient. Recommendations for healthcare systems to identify low-risk patients who can be safely discharged with timely outpatient follow-up have yet to be established. The primary objective of this study was to determine the role of patient predictors for the patients with LGIB to receive urgent endoscopic intervention. METHODS A retrospective chart review was performed on 142 patients. Data was collected on patient demographics, clinical features, comorbidities, medications, hemodynamic parameters, laboratory values, and diagnostic imaging. Logistic regression analysis, independent samples t-testing, Mann Whitney U testing for non-parametric data, and univariate analysis of categorical variables by Chi square test was performed to determine relationships within the data. RESULTS On logistic regression analysis, A hemoglobin drop of > 20 g/L was the only variable that predicted endoscopic intervention (p = 0.030). Tachycardia, hypotension, or presence of anticoagulation were not significantly associated with endoscopic intervention (p > 0.05). CONCLUSIONS A hemoglobin drop of > 20 g/L was the only patient parameter that predicted the need for urgent endoscopic intervention in the emergency department.
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Affiliation(s)
- Barzany Ridha
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Royal University Hospital, 104 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada.
| | - Nigel Hey
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Royal University Hospital, 104 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Lauren Ritchie
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Royal University Hospital, 104 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Ryan Toews
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Royal University Hospital, 104 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Zachary Turcotte
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Royal University Hospital, 104 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
| | - Brad Jamison
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Royal University Hospital, 104 Hospital Drive, Saskatoon, SK, S7N 0W8, Canada
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19
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Lee AY, Cho JY. Advancements in hemostatic strategies for managing upper gastrointestinal bleeding: A comprehensive review. World J Gastroenterol 2024; 30:2087-2090. [DOI: 10.3748/wjg.v30.i15.2087] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/20/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
Upper gastrointestinal (GI) hemorrhage presents a substantial clinical challenge. Initial management typically involves resuscitation and endoscopy within 24 h, although the benefit of very early endoscopy (< 12 h) for high-risk patients is debated. Treatment goals include stopping acute bleeding, preventing rebleeding, and using a multimodal approach encompassing endoscopic, pharmacological, angiographic, and surgical methods. Pharmacological agents such as vasopressin, prostaglandins, and proton pump inhibitors are effective, but the increase in antithrombotic use has increased GI bleeding morbidity. Endoscopic hemostasis, particularly for nonvariceal bleeding, employs techniques such as electrocoagulation and heater probes, with concerns over tissue injury from monopolar electrocoagulation. Novel methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have limitations. Currently, the first-line therapy includes thermal probes and hemoclips, with over-the-scope clips emerging for larger ulcer bleeding. The gold probe, combining bipolar electrocoagulation and injection, offers targeted coagulation but has faced device-related issues. Future advancements involve combining techniques and improving endoscopic imaging, with studies exploring combined approaches showing promise. Ongoing research is crucial for developing standardized and effective hemorrhage management strategies.
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Affiliation(s)
- Ah Young Lee
- Division of Gastroenterology, Department of Internal Medicine, Cha Gangnam Medical Center, Cha University College of Medicine, Seoul 06135, Korea
| | - Joo Young Cho
- Division of Gastroenterology, Department of Internal Medicine, Cha Gangnam Medical Center, Cha University College of Medicine, Seoul 06135, Korea
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20
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Venezia L, Labarile N, Maselli R, Benedetti A, Annibale B, Parodi MC, Soncini M, Zingone F. Women in Gastroenterology: What Is the Current Situation? Results of an Italian National Survey. Dig Dis Sci 2024:10.1007/s10620-024-08407-8. [PMID: 38637458 DOI: 10.1007/s10620-024-08407-8] [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: 12/10/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Many women grow up dreaming of becoming doctors, preferring specialties that allow more focus on time outside the hospital and on family life. Nowadays, specialties, like gastroenterology, have still a significant gender gap. METHODS Based on this known discrepancy, a web-based questionnaire was designed by the Young Component of the Scientific Committee of the Federation of Italian Scientific Societies of Digestive Diseases 2023 (FISMAD) to examine the current situation of female gastroenterologists in Italy. The survey, designed specifically for this study, was sent by email to all female gastroenterologists and residents gastroenterologists, members of the three major Italian societies of Gastroenterology. RESULTS A total of 423 female physicians responded to the survey: 325 (76.8%) had full-time employment, and only a few had an academic career (7.2%). The main occupations were outpatient clinics (n = 288, 68%) and diagnostic endoscopy (n = 289, 68.3%); only 175 (41.3%) performed interventional endoscopy. One hundred and forty-seven (34.7%) had the chance to attend a master in advanced or interventional endoscopy, while 133 (31.4%) faced disadvantages that enabled them to attend. Of the 244 (58%) who reported feeling underappreciated, 194 (79.5%) said it was due to gender bias. We found that women doctors considered themselves disadvantaged compared with men doctors due to career opportunities (n = 338), salary negotiations (n = 64), and training opportunities (n = 144). CONCLUSIONS In conclusion, gastroenterology still has a long way to go before approaching greater gender parity.
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Affiliation(s)
- Ludovica Venezia
- Gastroenterology Unit, Department of Oncological and Specialty Medicine, Azienda Ospedaliero-Universitaria 'Maggiore Della Carità', Novara, Italy
| | - Nunzia Labarile
- National Institute of Gastroenterology - IRCCS "Saverio de Bellis", Castellana Grotte, Italy
| | - Roberta Maselli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy
| | - Antonio Benedetti
- Department of Clinic and Molecular Sciences, Polytechnic University of Marche, Via Tronto 10, Ancona, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sant'Andrea Teaching Hospital, Sapienza University of Rome, Rome, Italy
| | - Maria Caterina Parodi
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Teaching Hospital San Martino, Genoa, Italy
| | - Marco Soncini
- Department of Internal Medicine, A. Manzoni Hospital, Lecco, Italy
| | - Fabiana Zingone
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
- Gastroenterology Unit, Azienda Ospedale - Università Padova, Via Giustiniani 2, Padua, Italy.
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Abe H, Sako T, Yamamoto Y, Ikeda A, Kawara F, Ose T, Takao T, Kitamura Y, Ariyoshi R, Morita Y, Ishida T, Ikegawa T, Ishida R, Yoshizaki T, Sakaguchi H, Toyonaga T, Kodama Y. Randomised controlled, patient-blinded, multicentre, superiority trial to evaluate the efficacy of the line-attached sheath-type traction device for endoscopic submucosal dissection in patients with superficial gastric neoplasms. BMJ Open 2024; 14:e078974. [PMID: 38631838 PMCID: PMC11029205 DOI: 10.1136/bmjopen-2023-078974] [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] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION EndoTrac is a line-attached sheath-type traction device that enables us to control the direction and the force of traction during endoscopic submucosal dissection (ESD). The efficacy of EndoTrac for gastric ESD has not been fully verified. METHODS AND ANALYSIS The G-Trac study is a multicentre (nine general hospitals and two university hospitals in Japan) collaborative trial assessing the efficacy of EndoTrac for gastric ESDs. Patients with superficial gastric neoplasms will be enrolled and randomly assigned to undergo either conventional ESD or EndoTrac ESD. Allocation will be stratified according to tumour location, operator experience and tumour diameter at an allocation rate of 1:1. The type of endoknife used will be confirmed before randomisation. The primary outcome, procedure time, will be compared between the groups in both intention-to-treat and per-protocol analyses using the Wilcoxon rank sum test. The efficacy-related, safety-related and device-related outcomes will be assessed in the secondary analysis. The planned sample size of the 142 patients in the two groups will enable us to detect a difference with a power of 80% by using the Wilcoxon rank sum test, assuming an effect size of 0.54, asymptotic relative efficiency of 0.864 and a two-sided type 1 error rate of 5%. ETHICS AND DISSEMINATION This trial was approved by the certified review board of Kobe University (22 December 2022). The results from this trial will be disseminated through peer-review journals, presentations at national and international conferences, and data sharing with other researchers. TRIAL REGISTRATION NUMBER jRCT1052220166.
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Affiliation(s)
- Hirofumi Abe
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Tomoya Sako
- Department of Gastroenterology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | | | - Atsushi Ikeda
- Department of Gastroenterology, Sanda City Hospital, Sanda, Japan
| | - Fumiaki Kawara
- Department of Gastroenterology, Konan Medical Center, Kobe, Japan
| | - Takayuki Ose
- Department of Gastroenterology, Kitaharima Medical Center, Ono, Japan
| | - Toshitatsu Takao
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Yasuaki Kitamura
- Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan
| | - Ryusuke Ariyoshi
- Department of Gastroenterology, Hyogo Prefectural Harima-Himeji General Medical Center, Himeji, Japan
| | - Yoshinori Morita
- Department of Gastroenterology, Kobe University International Clinical Cancer Research Center, Kobe, Japan
| | - Tsukasa Ishida
- Department of Gastroenterology, Akashi Medical Center, Akashi, Japan
| | - Takuya Ikegawa
- Department of Gastroenterology, Japanese Red Cross Kobe Hospital, Kobe, Japan
| | - Ryosuke Ishida
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Tetsuya Yoshizaki
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | - Hiroya Sakaguchi
- Department of Internal Medicine, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
| | | | - Yuzo Kodama
- Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine School of Medicine, Kobe, Japan
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22
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Abouzid M, Abdelhakeem A, Elshafie S, Ghorab A. Heyde's syndrome: a challenging case of severe aortic stenosis and gastrointestinal bleeding. BMJ Case Rep 2024; 17:e258316. [PMID: 38631812 PMCID: PMC11029456 DOI: 10.1136/bcr-2023-258316] [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] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
We present the case of an elderly man with a history of diastolic congestive heart failure, severe aortic stenosis and atrial fibrillation, who presented with fatigue, weakness, coffee ground emesis and black tarry stool. Haemoglobin was 68 g/L. Lactate dehydrogenase was elevated at 1038. Evaluation by cardiology and gastroenterology specialists revealed reflux oesophagitis and a mild hiatal hernia on oesophagogastroduodenoscopy, normal colonoscopy and small bowel series without obstruction. Capsule endoscopy identified angiodysplasia in the small intestine.The patient was diagnosed with Heyde's syndrome based on the triad of severe aortic stenosis, gastrointestinal bleeding from angiodysplasia and acquired von Willebrand syndrome. The patient underwent transcatheter aortic valve replacement, resulting in the resolution of symptoms.Heyde's syndrome represents a challenging clinical entity requiring a multidisciplinary approach for accurate diagnosis and management. Early recognition, prompt intervention and interdisciplinary collaboration are crucial in optimising patient outcomes.
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Affiliation(s)
- Mohamed Abouzid
- Department of Medicine, Baptist Hospitals of Southeast Texas, Beaumont, Texas, USA
| | - Ahmed Abdelhakeem
- Department of Medicine, Baptist Hospitals of Southeast Texas, Beaumont, Texas, USA
| | - Shorouk Elshafie
- Department of Medicine, Baptist Hospitals of Southeast Texas, Beaumont, Texas, USA
| | - Ahmad Ghorab
- Department of Hematology and Oncology, Mayo Clinic, Jacksonville, Florida, USA
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23
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Kim JY, Heo DH. Biportal endoscopic cervical open-door laminoplasty to treat cervical spondylotic myelopathy. Acta Neurochir (Wien) 2024; 166:182. [PMID: 38632148 DOI: 10.1007/s00701-024-06076-0] [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] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Although cervical laminoplasty is a frequently utilized surgical intervention for cervical spondylotic myelopathy, it is primarily performed using conventional open surgical techniques. We attempted the minimally invasive cervical laminoplasty using biportal endoscopic approach. METHODS Contralateral lamina access is facilitated by creating space through spinous process drilling, followed by lamina hinge formation. Subsequently, the incised lamina is elevated from ipsilateral aspect, and secure metal plate fixation is performed. CONCLUSION We successfully performed the cervical open door laminoplasty using biportal endoscopic approach. Biportal endoscopic cervical open-door laminoplasty may be a minimally invasive technique that can prevent complications related with open surgery.
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Affiliation(s)
- Ji Yeon Kim
- Department of Neurosurgery, Spine Center, Seran General Hospital, Seoul, South Korea
| | - Dong Hwa Heo
- Department of Neurosurgery, Endoscopic Spine Surgery Center, Harrison Spinartus Hospital Chungdam, 646 Samseong-ro, Gangnam-gu, Seoul, 06084, South Korea.
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24
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Kogilathota Jagirdhar GS, Perez JA, Banga A, Qasba RK, Qasba RK, Pattnaik H, Hussain M, Bains Y, Surani S. Role of second look endoscopy in endoscopic submucosal dissection and peptic ulcer bleeding: Meta-analysis of randomized controlled trials. World J Gastrointest Endosc 2024; 16:214-226. [DOI: 10.4253/wjge.v16.i4.214] [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: 12/25/2023] [Revised: 02/04/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Second-look endoscopy (SLE) to prevent recurrent bleeding in patients with peptic ulcer disease (PUD) and those undergoing endoscopic submucosal dissection (ESD) is routinely being performed. Conflicting evidence exists regarding efficacy, risk, benefit, and cost-effectiveness.
AIM To identify the role and effectiveness of SLE in ESD and PUD, associated rebleeding and PUD-related outcomes like mortality, hospital length of stay, need for endoscopic or surgical intervention and blood transfusions.
METHODS A systematic review of literature databases PubMed, Cochrane, and Embase was conducted from inception to January 5, 2023. Randomized controlled trials that compared patients with SLE to those who did not have SLE or evaluated the role of prophylactic hemostasis during SLE compared to other conservative interventions were included. The study was conducted per PRISMA guidelines, and the protocol was registered in PROSPERO (ID CRD42023427555:). RevMan was used to perform meta-analysis, and Mantel-Haenszel Odds ratio (OR) were generated using random effect models.
RESULTS A total of twelve studies with 2687 patients were included in our systematic review and meta-analysis, of which 1074 patients underwent SLE after ESD and 1613 patients underwent SLE after PUD-related bleeding. In ESD, the rates of rebleeding were 7% in the SLE group compared to 4.4% in the non-SLE group with OR 1.65, 95% confidence intervals (CI) of 0.96 to 2.85; P = 0.07, whereas it was 11% in the SLE group compared to 13% in the non-SLE group with OR 0.8 95%CI: 0.50 to 1.29; P = 0.36. The mean difference in the blood transfusion rates in the SLE and no SLE group in PUD was OR 0.01, 95%CI: -0.22 to 0.25; P = 0.91. In SLE vs non-SLE groups with PUD, the OR for Endoscopic intervention was 0.29, 95%CI: 0.08 to 1.00; P = 0.05 while it was OR 2.03, 95%CI: 0.95 to 4.33; P = 0.07, for surgical intervention. The mean difference in the hospital length of stay was -3.57 d between the SLE and no SLE groups in PUD with 95%CI: -7.84 to 0.69; P = 0.10, denoting an average of approximately 3 fewer days of hospital stay among patients with PUD who underwent SLE. For mortality between SLE and non-SLE groups in PUD, the OR was 0.88, 95%CI: 0.45 to 1.72; P = 0.70.
CONCLUSION SLE does not confer any benefit in preventing ESD and PUD-associated rebleeding. SLE also does not provide any significant improvement in mortality, need for interventions, or blood transfusions in PUD patients. SLE decreases the hospital length of stay on average by 3.5 d in PUD patients.
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Affiliation(s)
| | - Jose Andres Perez
- Department of Medicine, Saint Francis Health Systems, Tulsa, OK 74133, United States
| | - Akshat Banga
- Department of Internal Medicine, Sawai Man Singh Medical College, Jaipur 302004, India
| | - Rakhtan K Qasba
- Department of Medicine, Green Life Medical College and Hospital, Dhaka 1205, Bangladesh
| | - Ruman K Qasba
- Department of Medicine, Sher-i-kashmir Institute of Medical Science, Jammu, Srinagar 190011, India
| | - Harsha Pattnaik
- Department of Medicine, Lady Hardinge Medical College, New Delhi 110001, India
| | - Muhammad Hussain
- Department of Gastroenterology, Saint Michaels Medical Center, Newark, NJ 07102, United States
| | - Yatinder Bains
- Department of Gastroenterology, Saint Michaels Medical Center, Newark, NJ 07102, United States
| | - Salim Surani
- Department of Medicine and Pharmacology, Texas AM University, College Station, TX 77843, United States
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25
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Guan G, Zhuoga S, Zheng S, Xu K, Weng T, Qian W, Ji D, Yu X. A New Risk Prediction Model for Detecting Endoscopic Activity of Ulcerative Colitis. Gut Liver 2024:gnl230370. [PMID: 38623059 DOI: 10.5009/gnl230370] [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: 09/19/2023] [Revised: 12/13/2023] [Accepted: 01/11/2024] [Indexed: 04/17/2024] Open
Abstract
Background/Aims : Ulcerative colitis (UC) is an incurable, relapsing-remitting inflammatory disease that increases steadily. Mucosal healing has become the primary therapeutic objective for UC. Nevertheless, endoscopic assessments are invasive, expensive, time-consuming, and inconvenient. Therefore, it is crucial to develop a noninvasive predictive model to monitor endoscopic activity in patients with UC. Methods : Clinical data of 198 adult patients with UC were collected from January 2016 to August 2022 at Huadong Hospital, China. Results : Patients with UC were randomly divided into the training cohort (70%, n=138) and the validation cohort (30%, n=60). The receiver operating characteristic curve value for the training group was 0.858 (95% confidence interval [CI], 0.781 to 0.936), whereas it was 0.845 (95% CI, 0.731 to 0.960) for the validation group. The calibration curve employed the Hosmer-Lemeshow test (p>0.05) to demonstrate the consistency between the predicted and the actual probabilities in the nomogram of these two groups. The decision curve analysis validated that the nomogram had clinical usefulness. Conclusions : The nomogram, which incorporated activated partial thromboplastin time, fecal occult blood test, β2-globulin level, and fibrinogen degradation products, served as a prospective tool for evaluating UC activity in clinical practices.
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Affiliation(s)
- Guoyu Guan
- Department of Gastroenterology, Huadong Hospital, Shanghai Medical College Fudan University, Shanghai, China
| | - Sangdan Zhuoga
- Department of Gastroenterology, Huadong Hospital, Shanghai Medical College Fudan University, Shanghai, China
| | - Songbai Zheng
- Department of Gastroenterology, Huadong Hospital, Shanghai Medical College Fudan University, Shanghai, China
| | - Kangqiao Xu
- Department of Respiration, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingwen Weng
- Department of Cardiology, Huadong Hospital, Shanghai Medical College Fudan University, Shanghai, China
| | - Wensi Qian
- Department of Hematology, Huadong Hospital, Shanghai Medical College Fudan University, Shanghai, China
| | - Danian Ji
- Department of Endoscopy Center, Huadong Hospital, Shanghai Medical College Fudan University, Shanghai, China
| | - Xiaofeng Yu
- Department of General Practice, Huadong Hospital, Shanghai Medical College Fudan University, Shanghai, China
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26
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Suzuki Y, Ochiai Y, Kikuchi D, Koseki M, Ohashi K, Hoteya S. Long-term Outcome of Asymptomatic Esophageal Eosinophilia. Gut Liver 2024:gnl230398. [PMID: 38623060 DOI: 10.5009/gnl230398] [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: 09/30/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 04/17/2024] Open
Abstract
Background/Aims : Asymptomatic esophageal eosinophilia (aEE), characterized by eosinophil infiltration in the esophagus without clinical symptoms, has been reported as a precursor of eosinophilic esophagitis (EoE). Nevertheless, no report exists on the long-term clinical course of the disease. Therefore, this study aimed to investigate the long-term clinical course of aEE over 5 years, including the symptomatic conversion rate and the effect of treatments. Methods : We reviewed 28 patients with aEE who had been followed up for over 5 years with endoscopic monitoring. The basal characteristics of patients were compared with those of 58 patients diagnosed with EoE during the same period. Patients' clinicopathological findings were collected and examined. Results : No significant differences in basal characteristics and histopathological findings were observed between the patients with aEE and those with EoE. The median follow-up duration was 64 months. Among the 28 patients with aEE, seven were treated with proton pump inhibitor or potassium-competitive acid blocker and the remaining 21 opted for follow-up with no medication. Among the treated patients, six (85.7%) exhibited endoscopic and pathologic improvements. Among the cases followed up without medication, the findings worsened in two (9.5%), improved spontaneously in seven (33.3%), and were unchanged in 12 (57.1%), and three (14.3%) developed symptoms at a mean time of 40 months. Symptoms developed in cases where endoscopic and pathologic findings remained unchanged or worsened during follow-up. Conclusions : Some patients with aEE had improved findings without treatment, whereas others developed symptoms, emphasizing the importance of long-term monitoring and individualized treatment decisions.
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Affiliation(s)
- Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Yorinari Ochiai
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Mako Koseki
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Human Pathology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan
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27
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Mitsui T, Sunakawa H, Yoda Y, Nishio M, Kondo S, Hamanaka J, Tokoro C, Nakajo K, Maeda S, Yano T, Hirasawa K. Novel gastric endoscopic submucosal dissection training model enhances the endoscopic submucosal dissection skills of trainees: a multicenter comparative study. Surg Endosc 2024:10.1007/s00464-024-10838-3. [PMID: 38619558 DOI: 10.1007/s00464-024-10838-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) requires high endoscopic technical skills, and trainees should develop effective training methods. In collaboration with KOTOBUKI Medical, we developed the G-Master, which is a non-animal training model that can simulate various parts of gastric ESD. We aimed to clarify the usefulness of the G-Master for inexperienced ESD trainees. METHODS We collected data from the first 5 gastric ESD cases conducted by 15 inexperienced ESD trainees at 5 participating centers between 2018 and 2022. The participants were divided into two groups: the G-Master training and non-G-Master training groups. Outcome measurements, such as procedural speed, perforation rate, self-completion rate, and en bloc resection rate, were compared between the two groups retrospectively. RESULTS A total of 75 gastric ESD cases were included in this study. The G-Master training group included 25 cases performed by 5 trainees, whereas the non-G-Master training group included 50 cases performed by 10 trainees. The median procedural speed for all cases was significantly faster in the G-Master training group than in the non-G-Master training group. Moreover, the procedural speed was linearly improved from the initial to the last cases in the lower location in the G-Master training group compared with the non-G-Master training group. In addition, although there was no significant difference, the G-Master training group showed lower rates of perforation and a lesser need to transition to expert operators than the non-G-Master training group. CONCLUSION The G-Master could improve the ESD skills of inexperienced ESD trainees.
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Affiliation(s)
- Tomohiro Mitsui
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Division of Endoscopy, Saitama Cancer Center, Saitama, Japan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hironori Sunakawa
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
- NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Yusuke Yoda
- Division of Endoscopy, Saitama Cancer Center, Saitama, Japan
| | - Masafumi Nishio
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
| | - Shinpei Kondo
- Department of Gastroenterology, Fujisawa City Hospital, Kanagawa, Japan
| | - Jun Hamanaka
- Department of Gastroenterology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
| | - Chikako Tokoro
- Department of Gastroenterology, Saiseikai Yokohamashi Nannbu Hospital, Kanagawa, Japan
| | - Keiichiro Nakajo
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- NEXT Medical Device Innovation Center, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Kingo Hirasawa
- Division of Endoscopy, Yokohama City University Medical Center, Kanagawa, Japan
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28
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Monroy-Iglesias MJ, Martin S, Cargaleiro C, Jones G, Steward L, Murtagh C, Bruno F, Millwaters J, Schizas A, Watson H, Haire A, Haire K, Moss CL, Russell B, Srirajaskanthan R, Van Hemelrijck M, Dolly S. Real-world data evaluating Guy's rapid diagnostic clinic as an alternate pathway for patients with FIT levels below 10. BMJ Open 2024; 14:e080285. [PMID: 38626962 PMCID: PMC11029265 DOI: 10.1136/bmjopen-2023-080285] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/13/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To analyse the effectiveness of rapid diagnostic clinics (RDCs) as an alternative pathway for patients with concerning symptoms and a faecal immunochemical test (FIT) result <10. Our primary endpoint was rate of colorectal cancer (CRC) detection. Second endpoints were rates of other cancers and gastrointestinal (GI) serious benign conditions. Finally, we analysed the specific pathway followed by FIT <10 patients with cancer at Guy's and St Thomas NHS Foundation Trust (GSTT) RDC. DESIGN A retrospective and prospective cohort study. SETTING GSTT RDC, one of England's largest single-centre RDCs. Sociodemographic and clinical characteristics of FIT <10 patients were analysed descriptively. PARTICIPANTS Patients with an FIT result <10, seen at GSTT RDC between 1 January 2020 and 5 May 2023. RESULTS A total of 1299 patients with an FIT<10 were seen at GSTT RDC between January 2020 and May 2023. Of these, 66% (n=861) reported weight loss, 62% (n=805) pain, 37% (n=481) fatigue, 34% (n=444) were anaemic and 23% (n=301) had nausea and vomiting. Among these patients, 7% (n=88) received a cancer diagnosis, 36% (n=462) were identified as having a serious benign condition. Within the patients with cancer, 9% (n=8) were diagnosed with CRC. Among patients with serious benign conditions, 7% (n=31) were referred to colorectal, hepatopancreatobiliary, or upper GI specialists. CONCLUSION This study demonstrates the effectiveness of RDCs as an alternate pathway for FIT <10 patients with ongoing clinical concerns. These results contribute to enhancing patient care and optimising resource allocation within the healthcare system.
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Affiliation(s)
| | - Sabine Martin
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Carlos Cargaleiro
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Geraint Jones
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- Southeast London Cancer Alliance, London, UK
| | - Lindsay Steward
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Colette Murtagh
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Flaminia Bruno
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Juliet Millwaters
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Alexis Schizas
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Harriet Watson
- Department of Colorectal Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anna Haire
- Translational Oncology and Urology Research, King's College London, London, UK
| | - Kate Haire
- Southeast London Cancer Alliance, London, UK
| | | | - Beth Russell
- Translational Oncology and Urology Research, King's College London, London, UK
| | | | | | - Saoirse Dolly
- Medical Oncology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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Toyoshima O, Nishizawa T, Hata K. Topic highlight on texture and color enhancement imaging in gastrointestinal diseases. World J Gastroenterol 2024; 30:1934-1940. [DOI: 10.3748/wjg.v30.i14.1934] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/03/2024] [Accepted: 03/25/2024] [Indexed: 04/12/2024] Open
Abstract
Olympus Corporation developed texture and color enhancement imaging (TXI) as a novel image-enhancing endoscopic technique. This topic highlights a series of hot-topic articles that investigated the efficacy of TXI for gastrointestinal disease identification in the clinical setting. A randomized controlled trial demonstrated improvements in the colorectal adenoma detection rate (ADR) and the mean number of adenomas per procedure (MAP) of TXI compared with those of white-light imaging (WLI) observation (58.7% vs 42.7%, adjusted relative risk 1.35, 95%CI: 1.17-1.56; 1.36 vs 0.89, adjusted incident risk ratio 1.48, 95%CI: 1.22-1.80, respectively). A cross-over study also showed that the colorectal MAP and ADR in TXI were higher than those in WLI (1.5 vs 1.0, adjusted odds ratio 1.4, 95%CI: 1.2-1.6; 58.2% vs 46.8%, 1.5, 1.0-2.3, respectively). A randomized controlled trial demonstrated non-inferiority of TXI to narrow-band imaging in the colorectal mean number of adenomas and sessile serrated lesions per procedure (0.29 vs 0.30, difference for non-inferiority -0.01, 95%CI: -0.10 to 0.08). A cohort study found that scoring for ulcerative colitis severity using TXI could predict relapse of ulcerative colitis. A cross-sectional study found that TXI improved the gastric cancer detection rate compared to WLI (0.71% vs 0.29%). A cross-sectional study revealed that the sensitivity and accuracy for active Helicobacter pylori gastritis in TXI were higher than those of WLI (69.2% vs 52.5% and 85.3% vs 78.7%, respectively). In conclusion, TXI can improve gastrointestinal lesion detection and qualitative diagnosis. Therefore, further studies on the efficacy of TXI in clinical practice are required.
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Affiliation(s)
- Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology and Hepatology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
| | - Keisuke Hata
- Department of Gastroenterology, Nihonbashi Muromachi Mitsui Tower Midtown Clinic, Tokyo 103-0022, Japan
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30
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Liu Z, Tao Q, Wu Y, Zeng C, Chen Y. Comparable long‑term survival outcomes of endoscopic treatment versus surgical treatment for gastrointestinal stromal tumors with a diameter of 5-10 cm. Sci Rep 2024; 14:8513. [PMID: 38609414 PMCID: PMC11014986 DOI: 10.1038/s41598-024-58802-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Currently, endoscopic treatment for small gastrointestinal stromal tumors (GIST) has been widely accepted. However, for tumors larger than 5 cm, endoscopic treatment has not been recognized by national guidelines as the standard therapy due to concerns about safety and adverse tumor outcomes. Therefore, this study compares the long-term survival outcomes of endoscopic treatment and surgical treatment for GIST in the range of 5-10 cm. We selected patients with GIST from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015. Kaplan-Meier analysis and the log-rank test were employed to compare the long-term survival outcomes between endoscopic treatment and surgical treatment. A multivariate Cox proportional hazards model was used for analysis to identify risk factors influencing patient prognosis. To balance baseline data, we performed 1:1 propensity score matching (PSM). A total of 1223 GIST patients were included, with 144 patients (11.8%) received endoscopic treatment and 1079 patients (88.2%) received surgical treatment. Before PSM, there was no significant difference in the long-term survival rates between the two groups [5-year OS (86.5% vs. 83.5%, P = 0.42), 10-year OS (70.4% vs. 66.7%, P = 0.42)]. After adjusting for covariates, we found that the overall survival (HR = 1.26, 95% CI 0.89-1.77, P = 0.19) and cancer-specific survival (HR = 1.69, 95% CI 0.99-2.89, P = 0.053) risks were comparable between the endoscopic treatment group and the surgical treatment group. In the analysis after PSM, there was no significant difference between the endoscopic treatment group and the surgical treatment group. Our study found that for GIST patients with tumor sizes between 5 and 10 cm, the long-term OS and CSS outcomes were similar between the endoscopic treatment group and the surgical treatment group.
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Affiliation(s)
- Zide Liu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Qing Tao
- Department of Gastroenterology, Digestive Disease Hospital, The First Affliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yonghui Wu
- Department of Gastroenterology, Digestive Disease Hospital, The First Affliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Chunyan Zeng
- Department of Gastroenterology, Digestive Disease Hospital, The First Affliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi, China.
| | - Youxiang Chen
- Department of Gastroenterology, Digestive Disease Hospital, The First Affliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China.
- Jiangxi Clinical Research Center for Gastroenterology, Nanchang, Jiangxi, China.
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31
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Choe JW, Hyun JJ, Son SJ, Lee SH. Development of a predictive model for hypoxia due to sedatives in gastrointestinal endoscopy: a prospective clinical study in Korea. Clin Endosc 2024:ce.2023.198. [PMID: 38605689 DOI: 10.5946/ce.2023.198] [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: 08/04/2023] [Accepted: 12/05/2023] [Indexed: 04/13/2024] Open
Abstract
Background/Aims Sedation has become a standard practice for patients undergoing gastrointestinal (GI) endoscopy. However, considering the serious cardiopulmonary adverse events associated with sedatives, it is important to identify patients at high risk. Machine learning can generate reasonable prediction for a wide range of medical conditions. This study aimed to evaluate the risk factors associated with sedation during GI endoscopy and develop a predictive model for hypoxia during endoscopy under sedation. Methods This prospective observational study enrolled 446 patients who underwent sedative endoscopy at the Korea University Ansan Hospital. Clinical data were used as predictor variables to construct predictive models using the random forest method that is a machine learning algorithm. Results Seventy-two of the 446 patients (16.1%) experienced life-threatening hypoxia requiring immediate medical intervention. Patients who developed hypoxia had higher body weight, body mass index (BMI), neck circumference, and Mallampati scores. Propofol alone and higher initial and total dose of propofol were significantly associated with hypoxia during sedative endoscopy. Among these variables, high BMI, neck circumference, and Mallampati score were independent risk factors for hypoxia. The area under the receiver operating characteristic curve for the random forest-based predictive model for hypoxia during sedative endoscopy was 0.82 (95% confidence interval, 0.79-0.86) and displayed a moderate discriminatory power. Conclusions High BMI, neck circumference, and Mallampati score were independently associated with hypoxia during sedative endoscopy. We constructed a model with acceptable performance for predicting hypoxia during sedative endoscopy.
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Affiliation(s)
- Jung Wan Choe
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jong Jin Hyun
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Seong-Jin Son
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Korea
| | - Seung-Hak Lee
- Biomedical Research Center, Korea University Ansan Hospital, Ansan, Korea
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Contini G, Mele E, Barneschi AC, Esposito C, Castagnetti M. Voiding cystourethrography in patients undergoing endoscopic decompression of duplex system ureteroceles: to do or not to do? Pediatr Surg Int 2024; 40:103. [PMID: 38598017 PMCID: PMC11006722 DOI: 10.1007/s00383-024-05665-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To assess the role of voiding cystourethrography (VCUG) in patients with duplex system ureterocele (DSU) undergoing endoscopic decompression (ED). MATERIALS AND METHODS This is a retrospective study of 75 consecutive patients with DSU undergoing ED [median (range) age, 6 (1-148) months]. Patients were divided into 3 groups, 33 with a VCUG showing vesicoureteral reflux (VUR) before ED (VUR-group), 22 with a VCUG negative for VUR (No-VUR-group), and 20 who did not undergo a VCUG (No-VCUG-group). Secondary surgery (SS) rate was compared among groups. RESULTS Groups were comparable for baseline characteristics. SS rate was 82% (27/33) in VUR-group vs. 32% (7/22) in the No-VUR-group (p = 0.0001), and 25% (5/20) in the No-VCUG-group (p = 0.001 vs. VUR-group, and 1 vs. No-VUR-group). In the VUR-group, 9 patients underwent preemptive endoscopic treatment of VUR during ED and SS rate was 44% (4/9) vs. 96% (23/24) in the remainder, p= 0.003. In the No-VCUG-group, a VCUG was performed during follow-up in 9/15 patients and showed reflux in all, although only 2 of these developed a (single) urinary tract infections. CONCLUSIONS SS rate was significantly higher in patients with preoperative VUR. Instead, it was not significantly different between patients without VUR and those who did not undergo a VCUG before ED, despite all the latter who underwent a VCUG during follow-up had evidence of VUR generally in the absence of symptoms. In our opinion, a VCUG could be limited to patients developing symptoms after ED. If a VCUG is performed before ED, a preemptive treatment of VUR should be taken into consideration.
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Affiliation(s)
- Giorgia Contini
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Ermelinda Mele
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Andrea Celeste Barneschi
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy
| | - Ciro Esposito
- Division of Pediatric Surgery, Federico II University of Naples, Naples, Italy
| | - Marco Castagnetti
- Division of Pediatric Urology, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, 00165, Rome, Italy.
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy.
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Yun GY, Ahn JM, Park JH, Oh HJ, Shim JJ, Yoon SM. Preliminary Report of Fully Endoscopic Microvascular Decompression. J Korean Neurosurg Soc 2024:jkns.2024.0003. [PMID: 38583999 DOI: 10.3340/jkns.2024.0003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024] Open
Abstract
Objective Microscopic microvascular decompression (MVD) has been considered to be a useful treatment modality for medically refractory hemifacial spasm (HFS) and trigeminal neuralgia (TN). But, the advent of the endoscopic era has presented new possibilities to MVD surgery. While the microscope remains a valuable tool, the endoscope offers several advantages with comparable clinical outcomes. Thus, fully endoscopic MVD (E-MVD) could be a reasonable alternative to microscopic MVD. This paper explores the safety and efficacy of the fully E-MVD technique. Methods A single-center retrospective study was conducted in 25 patients diagnosed with HFS between September 2019 and July 2023. All surgeries were performed by a single neurosurgeon using the fully E-MVD technique without any assistance of a microscope. The study reviewed intraoperative brainstem auditory evoked potentials and disappearance of the lateral spread response. Outcomes were assessed based on the patients' clinical status immediately after surgery and at their last follow-up. Complications, including facial palsy, hearing loss, ataxia, dysphagia, palsy of other cranial nerves, and cerebrospinal fluid (CSF) leakage, were also examined. Results The most common offending artery was the anterior inferior cerebellar artery (AICA) in 15 cases (60.0%), followed by the posterior inferior cerebellar artery (PICA) in 8 cases (32.0%), vertebral artery (VA) in 1 case (4.0%), tandem lesions involving the AICA and VA in 1 case (4.0%). Ten patients (40.0%) had pre-operative facial palsy on the ipsilateral side, and 8 patients (32.0%) experienced delayed facial palsy on the ipsilateral side, from which they fully recovered by the last follow-up. The median operation time was 105 minutes. All patients were symptom free immediately after surgery and at the last follow-up. One patient experienced a permanent complication, such as high-frequency hearing loss, from which he partially recovered over time. Conclusion Fully E-MVD demonstrated similar clinical outcomes to microscopic MVD. It offered a similar complication rate, shorter operation time, and a panoramic view with a smaller craniectomy size. Although there is a learning curve associated with fully E-MVD, it presents a viable alternative in the endoscopic era.
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Affiliation(s)
- Gi-Yong Yun
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jae-Min Ahn
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jong-Hyun Park
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyuk-Jin Oh
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jai-Joon Shim
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Seok Mann Yoon
- Department of Neurosurgery, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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Nabi Z, Reddy DN. Therapeutic endoscopy: Recent updates and future directions. Dig Liver Dis 2024:S1590-8658(24)00311-6. [PMID: 38584031 DOI: 10.1016/j.dld.2024.03.011] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/29/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024]
Abstract
The landscape of therapeutic endoscopy has undergone a remarkable evolution over the past few decades, carving out a niche that merges innovative technology with advanced clinical practice. As we venture further into the 21st century, the horizon of this field continues to expand, driven by rapid advancements in technology and a deeper understanding of gastrointestinal pathology. This review article aims to shed light on the recent advances and future trajectories of therapeutic endoscopy, focusing on pivotal areas such as third space endoscopy, endoscopic resection techniques, artificial endoscopy, endoscopic ultrasound (EUS), the integration of artificial intelligence (AI), and endoscopic anti-reflux therapies.
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Affiliation(s)
- Zaheer Nabi
- Consultant Gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India.
| | - D Nageshwar Reddy
- Chairman and Chief Gastroenterologist, Asian institute of Gastroenterology, Hyderabad, India.
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Guyot J, Beucler N, Almairac F. An unexpected etiology of cerebrospinal fluid leak post-transsphenoidal surgery. Acta Neurol Belg 2024:10.1007/s13760-024-02545-6. [PMID: 38573490 DOI: 10.1007/s13760-024-02545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/27/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Jean Guyot
- Neurosurgery department, Pasteur 2 Hospital, University Hospital of Nice, 30 Avenue de La Voie Romaine, 06000, Nice, France.
| | - Nathan Beucler
- Neurosurgery department, Sainte-Anne Military Teaching Hospital, Toulon, France
| | - Fabien Almairac
- Neurosurgery department, Pasteur 2 Hospital, University Hospital of Nice, 30 Avenue de La Voie Romaine, 06000, Nice, France
- UR2CA PIN, Université Côte d'Azur, Nice, France
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Ochiai Y, Ito S, Kikuchi D, Hoteya S. Long-term endoscopic change of gastric polyp associated with administration of vonoprazan. Clin J Gastroenterol 2024:10.1007/s12328-024-01961-8. [PMID: 38575803 DOI: 10.1007/s12328-024-01961-8] [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: 07/21/2023] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
Vonoprazan (VPZ) has been available in Japan since 2015. Endoscopic features of proton-pump inhibitor (PPI)-related gastric mucosal changes, including fundic gland and hyperplastic polyps, have been observed. However, the relationship between gastric polyps and VPZ remains unclear. A 65-year-old man with reflux esophagitis-associated symptoms refractory to PPI was referred to our hospital. VPZ (20 mg) was administered for 3 weeks, which proved effective. Afterward, VPZ dose was reduced to 10 mg; the reflux symptoms worsened, and 20 mg VPZ was restarted. Afterward, esophagogastroduodenoscopy (EGD) revealed a gradually enlarging gastric polyp in the cardia. After 5 years of VPZ administration, the patient developed a reddish polyp (approximately 10 mm) with a whitish substance in the cardia. Based on the clinical course, the polyp was considered to have enlarged because of the long-term VPZ administration. After being informed of the endoscopic findings, the patient decided to discontinue VPZ. One year after VPZ discontinuation, EGD revealed a shrunken polyp (5 mm). Long-term acid suppression causes hypergastrinemia, which may lead to gastric mucosal changes, including gastric polyps. There are few case reports of a decrease in the number and size of gastric polyps after VPZ discontinuation. Hence, some VPZ-induced endoscopic changes may be reversible.
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Affiliation(s)
- Yorinari Ochiai
- Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan.
| | - Shinji Ito
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Daisuke Kikuchi
- Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Tokyo, 105-8470, Japan
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Wang H, Nguyen M, Gupta S, Sidhu M, Cronin O, O'Sullivan T, Whitfield A, Lee EYT, Burgess NG, Bourke MJ. 'Long-term outcomes after endoscopic submucosal dissection for relative indication early gastric cancer in non-surgical candidates'. Gastrointest Endosc 2024:S0016-5107(24)00216-5. [PMID: 38580133 DOI: 10.1016/j.gie.2024.03.032] [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: 02/08/2024] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AND AIMS Endoscopic submucosal dissection (ESD) is effective in treating early gastric cancer (EGC). It's role in the comorbid with more advanced disease is unknown. We sought to evaluate this in a large Western cohort. METHODS Consecutive patients who underwent ESD for EGC in a single tertiary Western endoscopy centre over 10 years were prospectively analyzed. The primary outcomes were long term overall survival (OS) and disease-free survival (DFS) up to 5 years. Secondary outcomes were efficacy and serious adverse events (SAE). RESULTS ESD for 157 EGC in 149 patients were performed in an elderly and comorbid cohort with mean age 73.7 years and age-adjusted Charleson Comorbidity Index 4.2. Over a median follow-up period of 51.6 months, there was no significant difference in 5-year OS (88.9% vs 77.9%, P = 0.290) and DFS (83.2% vs 75.1%, P = 0.593) between absolute indication (AI) EGC and relative indication (RI) EGC. AI EGC cohort achieved higher en bloc (96.3% vs 87.5%, P = 0.069) and R0 resection rate (93.6% vs 62.5%, P <0.001) when compared to RI EGC. There were no significant differences in SAE (7.3% vs 12.5%, P = 0.363). No mortality or surgical resection ensued from ESD complications. CONCLUSION ESD safely confers DFS in poor surgical candidates with RI EGC in a large Western cohort. Patients who are elderly and comorbid or decline surgical resection may benefit from ESD and avoid the risks of surgery and its long-term sequelae.
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Affiliation(s)
- Hunter Wang
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Melinda Nguyen
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia
| | - Sunil Gupta
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Mayenaaz Sidhu
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Oliver Cronin
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Timothy O'Sullivan
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Anthony Whitfield
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Eric Y T Lee
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Nicholas G Burgess
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia
| | - Michael J Bourke
- Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, The University of Sydney, Sydney, Australia.
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Lim DH, Kim S, Lim JK, Sivakanthan S, Meyer RM, Kim P, Hofstetter CP, Rim BC. Endoscopic Posterior Cervical Foraminotomy under Lateral Decubitus Position with Local Anesthesia. World Neurosurg 2024:S1878-8750(24)00544-8. [PMID: 38575065 DOI: 10.1016/j.wneu.2024.03.158] [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] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
Endoscopic posterior cervical foraminotomy is gaining popularity among endoscopic spine surgeons for the treatment of radiculopathy caused by foraminal stenosis. This study describes a technique utilizing lateral decubitus position for an endoscopic posterior cervical foraminotomy under Monitored Anesthesia Care (MAC) and local anesthesia only. 10 patients with contraindications to general anesthesia underwent the procedure, resulting in an improvement in cervical radicular pain with no perioperative complications. The findings suggest that this approach is a viable alternative for high-risk patients for general anesthesia care, expanding the surgical options for the treatment of radiculopathy.
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Affiliation(s)
- Do H Lim
- Department of Neurological Surgery, University of Washington, USA.
| | - Samuel Kim
- University of Missouri-Kansas City School of Medicine, USA
| | - Jason K Lim
- Georgetown University School of Medicine, USA
| | | | - R Michael Meyer
- Department of Neurological Surgery, University of Washington, USA
| | - Patrick Kim
- Department of Neurological Surgery, University of South Florida, USA
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Ramai D, Morris JD, Fang J. Top Tips for Direct Percutaneous Endoscopic Jejunostomy (DPEJ) Tube Placement. Dig Dis Sci 2024:10.1007/s10620-024-08376-y. [PMID: 38564147 DOI: 10.1007/s10620-024-08376-y] [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: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 04/04/2024]
Abstract
Direct percutaneous endoscopic jejunostomy (DPEJ) provides post-pyloric enteral access in patients unable to meet long-term nutritional needs per os in situations where gastric feeding is neither tolerated nor feasible. Specific conditions associated with feeding intolerance due to due to nausea, vomiting, or ileus include gastric outlet obstruction, gastroparesis, or complications of acute or chronic pancreatitis; infeasibility may be due to high aspiration risk or prior gastric surgery. Since performing DPEJ is not an ACGME requirement for GI fellows or early career gastroenterologists, not all trainees are taught this technique. Hence, provider expertise for teaching and performing this technique varies widely across centers. In this article, we provide top tips for successful performance of DPEJ.
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Affiliation(s)
- Daryl Ramai
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah Health, Salt Lake City, UT, USA.
| | - John D Morris
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah Health, Salt Lake City, UT, USA
| | - John Fang
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah Health, Salt Lake City, UT, USA
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Panzuto F, Parodi MC, Esposito G, Massironi S, Fantin A, Cannizzaro R, Milione M, De Angelis CG, Annibale B. Endoscopic management of gastric, duodenal and rectal NETs: Position paper from the Italian Association for Neuroendocrine Tumors (Itanet), Italian Society of Gastroenterology (SIGE), Italian Society of Digestive Endoscopy (SIED). Dig Liver Dis 2024; 56:589-600. [PMID: 38216439 DOI: 10.1016/j.dld.2023.12.015] [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: 11/08/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/14/2024]
Abstract
The present paper reflects the position of the Italian Association for Neuroendocrine Tumors (Itanet), the Italian Society of Gastroenterology (SIGE), and the Italian Society of Digestive Endoscopy (SIED) regarding the management of patients affected by gastric, duodenal, and rectal neuroendocrine neoplasms (NENs) amenable to endoscopic treatment. The key questions discussed in this paper are summarized in Table 1. Data were extracted from the MEDLINE database through searches; expert opinions and recommendations are provided in accordance with the available scientific evidence and the authors' expertise. Recommendations are presented alongside a level of evidence and grade of recommendation based on the GRADE system. This paper specifically focuses on subgroups of NENs considered suitable for endoscopic management according to current international guidelines: i. well-differentiated gastric neuroendocrine tumors (gNET) type 1 < 2 cm and selected cases of type 3; ii. well-differentiated duodenal, non-functioning, non-ampullary NET with size < 2 cm; and well-differentiated rectal NET with size < 2 cm.
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Affiliation(s)
- Francesco Panzuto
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy.
| | - Maria Caterina Parodi
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Teaching Hospital San Martino, Genova, Italy
| | - Gianluca Esposito
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - Sara Massironi
- Division of Gastroenterology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Fantin
- Gastroenterology Unit; Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Renato Cannizzaro
- Oncological Gastroenterology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
| | - Massimo Milione
- Pathology First Division, Department of Pathology and Laboratory Medicine, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Giovanni De Angelis
- Gastroenterology Department, Endoscopy Unit, Azienda Ospedaliero Universitaria, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Bruno Annibale
- Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
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Zazour A, Belkhayat C, Bennani A, Bouziane M, Kharrasse G, Ismaili Z. Two cases of Dieulafoy's lesion in unusual sites: A rare case reports of gastrointestinal bleeding. Int J Surg Case Rep 2024; 117:109562. [PMID: 38518467 PMCID: PMC10972791 DOI: 10.1016/j.ijscr.2024.109562] [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] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION Dieulafoy's lesion (DL) is a vascular malformation that can lead to massive gastrointestinal bleeding. It's usually found in the stomach. However, DL's occurrence in atypical sites such as the small bowel and colon is exceptionally rare, posing significant management challenges. CASE PRESENTATION In this report, we present two cases of DL occurring in uncommon sites, each managed with distinct approaches. Case 1 is a 50-year-old man admitted to the emergency department due to massive GI bleeding and hemodynamic instability. The diagnosis of DL was established through computed tomography angiography and confirmed by histopathological examination after emergency surgery. Case 2 involves a 68-year-old woman presented with melena due to a colonic DL. This case was successfully managed through an endoscopic hemostasis approach. DISCUSSION Dieulafoy's lesions (DL) were first identified as a large submucosal artery lacking typical gastric ulcer characteristics in three of Paul Georges Dieulafoy's patients. This lesion is responsible for approximately 1-2 % of all cases of gastrointestinal bleeding. Endoscopy is the preferred method for diagnosing and managing DL lesions, especially in cases of active bleeding that is accessible. However, if endoscopic treatment or angiographic embolization fails, a surgical approach may be needed. CONCLUSION DL presents a diagnostic challenge due to its rarity and is not usually included in the differential diagnosis of gastrointestinal bleeding, particularly when occurring in unusual sites. Endoscopy is the preferred method to identify DL and a possible therapeutic approach in active bleeding. However, if endoscopy hemostasis fails, angiographic embolization or surgical intervention may be required.
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Affiliation(s)
- Abdelkrim Zazour
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco.
| | - Chifaa Belkhayat
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Amal Bennani
- Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Pathology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Mohamed Bouziane
- General Surgery Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Ghizlane Kharrasse
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
| | - Zahi Ismaili
- Hepato-gastroenterology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco; Laboratory of Digestive Disease Research, Faculty of Medicine and Pharmacy of Oujda, University of Mohammed First, Oujda, Morocco
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McArdle E, Shetty S, Coutinho D, Ramadan HH, Makary CA. Correlation of patient reported outcome measures with endoscopic findings in pediatric chronic adenoiditis and chronic rhinosinusitis. Int J Pediatr Otorhinolaryngol 2024; 179:111936. [PMID: 38583371 DOI: 10.1016/j.ijporl.2024.111936] [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: 03/07/2024] [Revised: 03/24/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Studies in adult chronic rhinosinusitis (CRS) showed poor correlation between patient reported outcome measures (PROMs) and objective findings. Our goal is to study the correlation between the sinus and nasal quality of life (SN-5) and the 22-items sinonasal outcome test (SNOT-22) surveys with endoscopy findings in children with chronic adenoiditis (CA) and CRS. METHODS Cross-sectional study of all pediatric patients (age 2-18) presenting for CA or CRS was performed. Patients and caregivers were asked to fill the SN-5 and SNOT-22 questionnaires at initial and follow up visits. Demographics and comorbidities were collected. Objective findings included endoscopy Modified Lund-Kennedy (MLK) scores and adenoid tissue size. RESULTS 124 children were included, with mean age of 9.9 years (SD = 4.8) and 46.8% female. 36.3% had allergic rhinitis, 23.4% had asthma, and 4% had obstructive sleep apnea. Moderate correlation was found between the rhinologic domain of SNOT-22 and MLK scores (r = 0.36, p = 0.001) and between SN5 scores and adenoid size in all patients (r = 0.39, p < 0.001). SNOT-22 scores showed moderate correlation with adenoid size (r = 0.42, p < 0.001) more specifically in CA patients (r = 0.54, p < 0.001). The correlation of SN5 and MLK scores were higher in children with allergic rhinitis or asthma. The correlation between SN5 and adenoid size was lower in children with allergic rhinitis or asthma. CONCLUSION There is discrepancy between the subjective measures and the objective findings in children with CA or CRS. The physical exam findings may not reflect the effect of CRS on the quality of life of children.
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Affiliation(s)
- Erica McArdle
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Sameer Shetty
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Dominic Coutinho
- School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Hassan H Ramadan
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA
| | - Chadi A Makary
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
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Cameron BA, Anderson CW, Jensen ET, Dellon ES. Vitamin D Levels as a Potential Modifier of Eosinophilic Esophagitis Severity in Adults. Dig Dis Sci 2024; 69:1287-1292. [PMID: 38183560 DOI: 10.1007/s10620-023-08264-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/27/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Vitamin D deficiency is associated with atopic and immune-mediated diseases but has not been extensively assessed in eosinophilic esophagitis (EoE). We aimed to assess if vitamin D levels in newly diagnosed EoE patients were lower than in non-EoE controls and examine levels in relation to EoE clinical features. METHODS This secondary analysis of a prospective cohort study used data and biosamples from adults who underwent outpatient esophagogastroduodenoscopy. Before each procedure, blood was obtained and stored at -80oC. Serum 25-hydroxy-vitamin D3 (25(OH)D3) was measured by ELISA. Levels for cases and controls were compared at baseline. Within cases, 25(OH)D3 levels were compared for clinical, endoscopic, and histologic measures. RESULTS We analyzed 40 EoE and 40 non-EoE controls. Mean serum 25(OH)D3 level was slightly lower in EoE patients than controls (30.9 ± 15.3 ng/mL vs. 35.9 ± 15.4; p = 0.15). After controlling for age, sex, and race, adjusted levels were 10.8 ng/mL lower in EoE patients (95% CI: -19.0, -2.5), but 25(OH)D3 deficiency (< 20ng/mL) was similar in cases and controls (20% vs. 15%; p = 0.56). Levels of 25(OH)D3 were not associated with differences in clinical or endoscopic features of EoE, and EREFS and eosinophil counts did not significantly correlate with 25(OH)D3 levels (R of -0.28 [p = 0.08] and - 0.01 [p = 0.93], respectively). 25(OH)D3 levels were lower in EoE cases with lamina propria fibrosis (23.2 ± 9.6 vs. 45.0 ± 17.7; p = 0.03). CONCLUSIONS After adjusting for age, sex, and race, 25(OH)D3 levels were lower in EoE cases than controls, but deficiency was not common. 25(OH)D3 levels were generally similar across most EoE disease features.
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Affiliation(s)
- Brenderia A Cameron
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, CB#7080 Bioinformatics Building 130 Mason Farm Rd. UNC-CH, Chapel Hill, NC, 27599-7080, USA
| | - Carlton W Anderson
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Elizabeth T Jensen
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, CB#7080 Bioinformatics Building 130 Mason Farm Rd. UNC-CH, Chapel Hill, NC, 27599-7080, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Gastroenterology Section, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, CB#7080 Bioinformatics Building 130 Mason Farm Rd. UNC-CH, Chapel Hill, NC, 27599-7080, USA.
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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Kobayashi K, Umekawa Y. Rapid progression from MDS to AML with gastric submucosal tumour as an extramedullary infiltration. BMJ Case Rep 2024; 17:e258856. [PMID: 38565228 PMCID: PMC10989113 DOI: 10.1136/bcr-2023-258856] [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] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
We present a rare case of myeloid sarcoma in the stomach of an elderly woman initially diagnosed with anaemia. Myeloid sarcoma, an unusual extramedullary manifestation of acute myeloid leukaemia (AML), primarily affects lymph nodes, bones, spine and skin, with gastrointestinal involvement being infrequent. Despite normal results from the initial endoscopy, a follow-up examination after 4 months revealed multiple submucosal gastric tumours. These developments coincided with worsening of anaemia and an increase in peripheral myeloblasts. Pathological evaluation and immunohistochemical staining confirmed gastric extramedullary infiltration associated with AML. This case highlights the importance of comprehensive diagnostic processes when suspecting leukaemic transformations, especially in myelodysplastic syndrome (MDS). Due to financial constraints, additional critical studies such as cytogenetics and next-generation sequencing were not performed. Nonetheless, this rare case demonstrates the visual observation of rapid progression from MDS to AML and concurrent early myeloid sarcoma development in an elderly patient.
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Affiliation(s)
- Keigo Kobayashi
- Department of Internal Medicine, General Incorporated Foundation Kurashiki Medical Center, Kurashiki, Okayama, Japan
| | - Yasuhiro Umekawa
- Department of Internal Medicine, General Incorporated Foundation Kurashiki Medical Center, Kurashiki, Okayama, Japan
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Elshaer A, Abraham NS. Management of Anticoagulant and Antiplatelet Agents in Acute Gastrointestinal Bleeding and Prevention of Gastrointestinal Bleeding. Gastrointest Endosc Clin N Am 2024; 34:205-216. [PMID: 38395479 DOI: 10.1016/j.giec.2023.09.002] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
Managing gastrointestinal bleeding in patients using antithrombotic agents remains challenging in clinical practice. This review article provides a comprehensive and evidence-based approach to managing acute antithrombotic-related gastrointestinal bleeding, focusing on the triage of patients, appropriate resuscitation, and timely endoscopy. The latest clinical practice guidelines are highlighted to guide decisions concerning the use of reversal agents, temporary interruption, and resumption of antithrombotic drugs. Additionally, preventive measures are discussed to lower the risk of future bleeding and minimize complications among patients prescribed antithrombotic drugs.
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Affiliation(s)
- Amany Elshaer
- Department of Internal Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
| | - Neena S Abraham
- Department of Internal Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
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Faizal B, Latheef B, Kartha N. Comparison of Video Nasopharyngoscopy and Tympanometry in Suspected Eustachian Tube Dysfunction - A Prospective Study. Indian J Otolaryngol Head Neck Surg 2024; 76:1682-1689. [PMID: 38566713 PMCID: PMC10982197 DOI: 10.1007/s12070-023-04384-y] [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] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/19/2023] [Indexed: 04/04/2024] Open
Abstract
Objective Tympanometry is widely used for diagnosing Eustachian tube dysfunction (ETD). However, in clinical practice, it is not uncommon to come across patients with symptoms of ETD with a normal tympanogram. Dynamic slow motion video endoscopy (DSMVE) of Eustachian tube (ET) and Eustachian tube dysfunction questionnaire-7 (ETDQ-7) are other tools to diagnose ETD. Primary aim of the study was to compare DSMVE and tympanometry in diagnosing ETD. Secondary objective was to find an association between DSMVE and ETDQ-7. It was a prospective diagnostic validity study in the department of Otorhinolaryngology at a tertiary care centre. Patients with symptoms suggestive of ETD with intact tympanic membrane (TM) and aged above 12 years were evaluated. The study duration was 17 months. The parameters assessed were tympanic membrane(TM) retraction by otoscopy, DSMVE, tympanometry and ETDQ-7 questionnaire. To test the significance of association and difference between tympanogram and nasopharyngoscopy, Chi-Square t test and McNemar's tests were applied. Out of 107 ears, DSMVE, tympanometry, ETDQ- 7 and otoscopy detected ETD in 51, 31,70 and 57 ears respectively. DSMVE and tympanometry together detected ETD in 29 ears and did not detect in 54 ears. Both these diagnostic methods were not comparable statistically (moderate agreement- Kappa value- 0.542). Comparison of DSMVE with ETDQ-7 was statistically significant (p-value- 0.004). Video nasopharyngoscopy cannot be a stand- alone diagnostic aid for ETD. ETDQ-7 questionnaire showed higher concordance with nasopharyngoscopy than tympanometry. Diagnostic accuracy was more when all four parameters were assessed together.
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Affiliation(s)
- Bini Faizal
- Department of ENT, Amrita institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, India
| | - Binshy Latheef
- Department of ENT, Amrita institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, India
| | - Niveditha Kartha
- Department of Biostatistics, Amrita institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, India
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Chang WK, Peng CL, Chen YW, Sun CK, Chen CC, Liu TC, Chu YY, Tsai IF, Chung CS, Lin HF, Hsu FY, Tai WC, Lee HC, Yen HH, Wang EM, Chen SH, Chu CH, Chen MJ, Lu CL, Chiu CT. Recommendations and guidelines for endoscope reprocessing: Current position statement of digestive endoscopic society of Taiwan. J Microbiol Immunol Infect 2024; 57:211-224. [PMID: 38135645 DOI: 10.1016/j.jmii.2023.12.001] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/23/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Reprocessing of gastrointestinal (GI) endoscopes and accessories is an essential part of patient safety and quality control in GI endoscopy centers. However, current endoscopic reprocessing guidelines or procedures are not adequate to ensure patient-safe endoscopy. Approximately 5.4 % of the clinically used duodenoscopes remain contaminated with high-concern microorganisms. Thus, the Digestive Endoscopy Society of Taiwan (DEST) sets standards for the reprocessing of GI endoscopes and accessories in endoscopy centers. DEST organized a task force working group using the guideline-revision process. These guidelines contain principles and instructions of step-by-step for endoscope reprocessing. The updated guidelines were established after a thorough review of the existing global and local guidelines, systematic reviews, and health technology assessments of clinical effectiveness. This guideline aims to provide detailed recommendations for endoscope reprocessing to ensure adequate quality control in endoscopy centers.
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Affiliation(s)
- Wei-Kuo Chang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Chen-Ling Peng
- Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan
| | - Yen-Wei Chen
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taiwan
| | - Cheuk-Kay Sun
- Division of Hepatology and Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11101, Taiwan
| | - Chieh-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Tao-Chieh Liu
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan
| | - Yin-Yi Chu
- Department of Gastroenterology and Hepatology, New Taipei Municipal Tucheng Hospital, Chang Gung University, Taoyuan, Taiwan
| | - I-Fang Tsai
- Ultrasonography and Endoscopy Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chen-Shuan Chung
- Ultrasonography and Endoscopy Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiao-Fen Lin
- Division of Gastroenterology and Hepatology, Renai Branch, Taipei City Hospital, Taiwan
| | - Fang-Yu Hsu
- Therapeutic Endoscopic Center, Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hsi-Chang Lee
- Division of Gastroenterology and Hepatology, Renai Branch, Taipei City Hospital, Taiwan
| | - Hsu-Heng Yen
- Division of Gastroenterology, Changhua Christian Hospital, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan
| | - E-Ming Wang
- Department of Internal Medicine Division of Gastroenterology and Hepatology, Kaohsiung Veterans General Hospital, Taiwan
| | - Shu-Hui Chen
- Division of Gastroenterology, Changhua Christian Hospital, Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan
| | - Cheng-Hsin Chu
- Division of Gastroenterology, Internal Medicine, MacKay Memorial Hospital, Taiwan
| | - Ming-Jen Chen
- Division of Gastroenterology, Internal Medicine, MacKay Memorial Hospital, Taiwan
| | - Ching-Liang Lu
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taiwan
| | - Cheng-Tang Chiu
- Department of Gastroenterology & Hepatology, Linkou Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Taiwan.
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Nakamichi R, Saito T, Shimamura Y, Hamada M, Nishida K, Ozaki T. Comparison of early clinical outcome in carpal tunnel release - mini-open technique with palmar incision vs. endoscopic technique with wrist crease incision. BMC Musculoskelet Disord 2024; 25:251. [PMID: 38561698 PMCID: PMC10983724 DOI: 10.1186/s12891-023-07151-w] [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: 07/31/2023] [Accepted: 12/23/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The purpose of this study was to examine two techniques for Carpal Tunnel Syndrome, mini-Open Carpal Tunnel Release (mini-OCTR) and Endoscopic Carpal Tunnel Release (ECTR), to compare their therapeutic efficacy. METHODS Sixteen patients who underwent mini-OCTR in palmar incision and 17 patients who underwent ECTR in the wrist crease incision were included in the study. All patients presented preoperatively and at 1, 3, and 6 months postoperatively and were assessed with the Visual Analogue Scale (VAS) and the Disabilities of Arm, Shoulder and Hand Score (DASH). We also assessed the pain and cosmetic VAS of the entire affected hand or surgical wound, and the patient's satisfaction with the surgery. RESULTS In the objective evaluation, both surgical techniques showed improvement at 6 months postoperatively. The DASH score was significantly lower in the ECTR group (average = 3 months: 13.6, 6 months: 11.9) than in the mini-OCTR group (average = 3 months: 27.3, 6 months: 20.6) at 3 and 6 months postoperatively. Also, the pain VAS score was significantly lower in the ECTR group (average = 17.1) than in the mini-OCTR group (average = 36.6) at 3 months postoperatively. The cosmetic VAS was significantly lower in the ECTR group (average = 1 month: 15.3, 3 months: 12.2, 6 months: 5.41) than in the mini-OCTR group (average = 1 month: 33.3, 3 months: 31.2, 6 months: 24.8) at all time points postoperatively. Patient satisfaction scores tended to be higher in the ECTR group (average = 3.3) compared to the mini-OCTR group (average = 2.7). CONCLUSIONS ECTR in wrist increase incision resulted in better pain and cosmetic recovery in an early postoperative phase compared with mini-OCTR in palmar incision. Our findings suggest that ECTR is an effective technique for patient satisfaction.
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Affiliation(s)
- Ryo Nakamichi
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Taichi Saito
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan.
| | - Yasunori Shimamura
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Masanori Hamada
- Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Keiichiro Nishida
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
| | - Toshifumi Ozaki
- Department of Sports Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-cho, Kitaku, 700-8558, Okayama, Japan
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Sun L, Shen Y, Huang L, Zhao J, Li M, Hu Y, Lyu B. Impact of endoscopic surveillance on the early diagnosis and endoscopic resection likelihood of gastric cancer. Surg Endosc 2024; 38:2188-2196. [PMID: 38448623 DOI: 10.1007/s00464-024-10748-4] [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] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Endoscopy could help detect early gastric cancer (EGC) and improve the prognosis of patients. The aim of this study was to analyze the impact of endoscopy and endoscopic surveillance on the early detection of gastric cancer (GC), GC staging, and treatment selection. METHODS Patients with GC diagnosed at our center from 2010 to 2022 were retrospectively analyzed and allocated to the short-interval group (had received endoscopy within 3 years before diagnosis), the long-interval group (had received endoscopy more than 3 years before diagnosis), and the unchecked group (had not received endoscopy before diagnosis). The differences in GC staging and treatment modalities among the three groups were analyzed, and the differences in the clinical and pathological features of EGC were further analyzed. RESULTS One thousand and twenty-five GC patients were included, with 395 cases of EGC and 630 cases of advanced GC. The proportions of EGC in the short-interval, long-interval, and unchecked groups were 98.0%, 84.2%, and 29.8%, respectively (p < 0.001). Among the 387 lesions of 367 EGC patients were resected by endoscopic submucosal dissection (ESD), 341 (88.1%) exhibited curative resection, and 46 (11.9%) involved noncurative resections. Lesions of EGC differed significantly in diameter, depth of invasion, and curative resection rate (p = 0.033, 0.019, and 0.005, respectively). In the short-interval group, 87.8% of the lesions were ≤ 2 cm, 95.6% of the invasion depths were confined to the mucosal layer, and 96.7% of the eCura scores were A or B. Compared with the unchecked group, they had smaller diameters (RR = 0.419, 95% CI 0.234-0.752), shallower invasion depths (RR = 0.286, 95% CI 0.105-0.777), and a higher curative resection rate (RR = 0.215, 95% CI 0.068-0.676). CONCLUSION Endoscopic surveillance at 3-year intervals can help detect EGC, and the EGC lesions found have smaller diameters and shallower depths of invasion, helping improve the curative resection rate of ESD.
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Affiliation(s)
- Lu Sun
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Youdian Street 54, Hangzhou, 310006, China
| | - Yanjie Shen
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Youdian Street 54, Hangzhou, 310006, China
| | - Liang Huang
- Department of Endoscopy Center, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Jing Zhao
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Youdian Street 54, Hangzhou, 310006, China
| | - Meng Li
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Youdian Street 54, Hangzhou, 310006, China
| | - Yue Hu
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Youdian Street 54, Hangzhou, 310006, China
| | - Bin Lyu
- Department of Gastroenterology, First Affiliated Hospital of Zhejiang Chinese Medical University, Youdian Street 54, Hangzhou, 310006, China.
- Key Laboratory of Digestive Pathophysiology of Zhejiang Province, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
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Han L, Li J, Liang C, Chu Y, Wang Y, Lv L, Liu D, Tan Y. Risk factors for positive resection margins after endoscopic resection for gastrointestinal neuroendocrine tumors. Surg Endosc 2024; 38:2041-2049. [PMID: 38429572 DOI: 10.1007/s00464-024-10706-0] [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] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/18/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND In recent years, the incidence of gastrointestinal neuroendocrine tumors (GI-NETs) has remarkably increased due to the widespread use of screening gastrointestinal endoscopy. Currently, the most common treatments are surgery and endoscopic resection. Compared to surgery, endoscopic resection possesses a higher risk of resection margin residues for the treatment of GI-NETs. METHODS A total of 315 patients who underwent surgery or endoscopic resection for GI-NETs were included. We analyzed their resection modality (surgery, ESD, EMR), margin status, Preoperative marking and Prognosis. RESULTS Among 315 patients included, 175 cases underwent endoscopic resection and 140 cases underwent surgical treatment. A total of 43 (43/175, 24.57%) and 10 (10/140, 7.14%) patients exhibited positive resection margins after endoscopic resection and surgery, respectively. Multivariate regression analysis suggested that no preoperative marking and endoscopic treatment methods were risk factors for resection margin residues. Among the patients with positive margin residues after endoscopic resection, 5 patients underwent the radical surgical resection and 1 patient underwent additional ESD resection. The remaining 37 patients had no recurrence during a median follow-up of 36 months. CONCLUSIONS Compared with surgery, endoscopic therapy has a higher margin residual rate. During endoscopic resection, preoperative marking may reduce the rate of lateral margin residues, and endoscopic submucosal dissection may be preferred than endoscopic mucosal resection. Periodical follow-up may be an alternative method for patients with positive margin residues after endoscopic resection.
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Affiliation(s)
- Liu Han
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Jianglei Li
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
- Xiangya School of Pharmaceutical Sciences, Central South University, Changsha, 410000, Hunan, China
| | - Chengbai Liang
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Yi Chu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Yongjun Wang
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Liang Lv
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China.
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China.
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
- Research Center of Digestive Diseases, Central South University, Changsha, 410011, Hunan, China.
- Clinical Research Center for Digestive Diseases in Hunan Province, Changsha, 410011, Hunan, China.
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