Journals

EUS-guided alcohol injection of pancreatic neuroendocrine tumor.

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EUS-guided alcohol injection of pancreatic neuroendocrine tumor.

Gastrointest Endosc. 2015 Apr 22;

Authors: Teoh AY, Chong CC, Chan AW, Lau JY

PMID: 25910658 [PubMed - as supplied by publisher]

Value of EGD in patients referred for cholecystectomy: a systematic review and meta-analysis.

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Value of EGD in patients referred for cholecystectomy: a systematic review and meta-analysis.

Gastrointest Endosc. 2015 Apr 22;

Authors: Lamberts MP, Kievit W, Özdemir C, Westert GP, van Laarhoven CJ, Drenth JP

Abstract

BACKGROUND: As many as 33% of patients with symptomatic cholelithiasis report persisting abdominal pain after cholecystectomy, suggesting alternative causes of these symptoms. EGD may serve as a tool to identify additional symptomatic abdominal disorders beforehand to avoid unnecessary gallbladder surgery. There is controversy as to whether routine EGD before cholecystectomy is appropriate.

OBJECTIVE: To perform a systematic review and meta-analysis to assess the value of EGD before cholecystectomy.

DESIGN: A systematic literature search was conducted to identify studies that reported the proportion of patients who were referred for cholecystectomy, but in whom initial surgery could be avoided after treatment of abnormalities detected with EGD. Pooled estimates with 95% confidence intervals (CIs) were calculated by using random-effects models.

SETTING: Meta-analysis of 12 cohort studies.

PATIENTS: A total of 6317 patients with cholelithiasis underwent EGD.

RESULTS: The pooled estimate of abnormalities detected with EGD was 36.3% (95% CI, 28.0-45.0). In a total of 3.8% (95% CI, 1.4-7.6) of patients referred for cholecystectomy who underwent previous EGD, gallbladder surgery was avoided.

LIMITATIONS: Lack of information regarding characteristics of patients referred for cholecystectomy, criteria for performing EGD, algorithms for the treatment of identified pathologies, and response criteria for the decision to avoid cholecystectomy in included studies.

CONCLUSIONS: Our study indicates that, despite the high diagnostic yield of EGD, its value as a tool to prevent gallbladder surgery is limited. EGD should only be considered selectively in patients with cholelithiasis referred for cholecystectomy.

PMID: 25910659 [PubMed - as supplied by publisher]

Endoscopic management of esophago-mediastinal fistula secondary to mediastinal tuberculosis infection.

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Endoscopic management of esophago-mediastinal fistula secondary to mediastinal tuberculosis infection.

Gastrointest Endosc. 2015 Apr 22;

Authors: Jáquez-Quintana JO, Rodríguez-Pendás F, De La Mora-Levy JG, Hernández-Guerrero AI

PMID: 25910660 [PubMed - as supplied by publisher]

Position change during colonoscope withdrawal increases polyp and adenoma detection in the right but not in the left side of the colon: results of a randomized controlled trial.

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Position change during colonoscope withdrawal increases polyp and adenoma detection in the right but not in the left side of the colon: results of a randomized controlled trial.

Gastrointest Endosc. 2015 Apr 22;

Authors: Ball AJ, Johal SS, Riley SA

Abstract

BACKGROUND: It has been suggested that changing patient position during colonoscope withdrawal increases adenoma detection. The results of previous studies have been conflicting.

OBJECTIVE: To evaluate whether routine position change during colonoscope withdrawal improves polyp detection.

DESIGN: Randomized, 2-way, crossover study.

SETTING: Teaching hospital.

PATIENTS: A total of 130 patients attending for diagnostic colonoscopy.

INTERVENTIONS: Patients undergoing colonoscopy had each colon segment examined twice: the right side of the colon (cecum to hepatic flexure) in the supine and left lateral position and the left side of the colon (splenic flexure and descending colon) in the supine and right lateral position. The transverse colon was examined twice in the supine position.

MAIN OUTCOME MEASUREMENTS: The primary outcome measure was the polyp detection rate (≥1 polyp) per colon segment. Secondary outcome measures included the number and proportion of patients with ≥1 adenoma in each segment and adequacy of luminal distension (1 = total collapse and 5 = no collapse).

RESULTS: Examination of the right side of the colon in the left lateral position significantly improved polyp detection (26.2% vs 17.7%; P = .01) and luminal distension (mean = 4.0 vs 3.5; P < .0001). Position change did not improve polyp detection in the left side of the colon (5.4% vs 4.6%; P = .99). There was no significant correlation between luminal distension and polyp detection in the right side of the colon (r = .03).

LIMITATIONS: Single center and open study design.

CONCLUSION: Examining the right side of the colon in the left lateral position increased polyp detection compared with examination in the supine position. Polyp detection in the left side of the colon was similar in the right lateral and supine positions. (Clinical trial registration number: NCT01554098.).

PMID: 25910661 [PubMed - as supplied by publisher]

EUS-guided pseudocyst drainage: prospective evaluation of early removal of fully covered self-expandable metal stents with pancreatic ductal stenting in selected patients.

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EUS-guided pseudocyst drainage: prospective evaluation of early removal of fully covered self-expandable metal stents with pancreatic ductal stenting in selected patients.

Gastrointest Endosc. 2015 Apr 22;

Authors: Dhir V, Teoh AY, Bapat M, Bhandari S, Joshi N, Maydeo A

Abstract

BACKGROUND: EUS-guided pseudocyst drainage with fully covered self-expandable metal stents (FCSEMSs) was recently described. The appropriate period for stent removal is not known.

OBJECTIVE: To assess the safety and efficacy of EUS-guided FCSEMS placement for 3 weeks, along with pancreatic ductal stenting in selected patients.

STUDY DESIGN: Prospective, single-center evaluation.

SETTING: Tertiary referral center.

PATIENTS: Symptomatic pseudocysts in the body and tail region of the pancreas.

INTERVENTIONS: EUS-guided transgastric placement of FCSEMS. MRCP was performed after 3 weeks. Patients with a suspected pancreatic duct leak underwent ERCP and plastic stent placement. The FCSEMSs were removed at 3 weeks.

MAIN OUTCOME MEASUREMENTS: Success of FCSEMS placement, adverse events, and recurrence rate.

RESULTS: Forty-seven patients met the eligibility criteria. Technical and functional success was achieved in 43 patients (intention to treat, 91.48% and 95.34% patients [per protocol, 41/43, respectively]). Adverse events occurred in 2 patients (cyst infections, 4.6%). Follow-up of 42 patients at 3 weeks was performed. MRCP detected a ductal leak in 3 patients (7.1%) and a disconnected duct in 2 patients (4.7%). ERCP and stenting were successful in all 3 patients with a ductal leak. During a median follow-up of 306 days in 42 patients, 2 recurrences (4.7%) were detected, both in patients with disconnected duct. Multivariate analysis showed that pancreatic ductal leak or disconnection was an independent factor affecting pseudocyst resolution at 3 weeks (P = .0001).

LIMITATIONS: Single-center study.

CONCLUSION: Short-term placement of FCSEMSs with pancreatic ductal stenting in selected patients appears safe and effective for the treatment of pseudocysts.

PMID: 25910662 [PubMed - as supplied by publisher]

Patient preferences of a resect and discard paradigm.

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Patient preferences of a resect and discard paradigm.

Gastrointest Endosc. 2015 Apr 22;

Authors: Vu HT, Sayuk GS, Gupta N, Hollander T, Kim A, Early DS

Abstract

BACKGROUND: Resect and discard is a new paradigm for management of diminutive polyps. It is unknown whether patients will embrace this new paradigm in which small polyps would not be sent for histopathologic review.

OBJECTIVE: To determine whether patients would be willing to pay for pathology costs with their own money and which factors influence patients’ decisions to pay or not pay for pathology costs with their own money.

DESIGN: Single-center, prospective, survey study.

SETTING: Hospital outpatient endoscopy center.

PATIENTS: Adults undergoing colonoscopy for screening or routine polyp surveillance.

INTERVENTIONS: Patient survey.

MAIN OUTCOME MEASUREMENTS: Willingness to pay out-of-pocket for pathology costs when a diminutive polyp is found and factors that influence patients’ decisions to pay or not pay for pathology costs with their own money.

RESULTS: A total of 500 participants completed the survey. A total of 360 respondents (71.9%) indicated a hypothetical willingness to pay out-of-pocket for histopathologic polyp analysis if this interpretation was not covered by insurance. Patient factors significantly associated with willingness to pay for polyp analysis included higher income and education and female sex.

LIMITATIONS: Single center, hypothetical situation.

CONCLUSION: Over two-thirds of patients were willing to pay to have their diminutive polyp sent for pathologic evaluation if their insurance carrier would not pay the cost. Factors associated with willingness to pay included higher income, higher education, and female sex. Patients who were unwilling to pay raised concerns about cost and are less concerned about cancer risk compared with those willing to pay. (Clinical trial registration number: NCT02305251.).

PMID: 25910663 [PubMed - as supplied by publisher]

Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis.

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Polidocanol injection decreases the bleeding rate after colon polypectomy: a propensity score analysis.

Gastrointest Endosc. 2015 Apr 22;

Authors: Facciorusso A, Di Maso M, Antonino M, Del Prete V, Panella C, Barone M, Muscatiello N

Abstract

BACKGROUND: EMR is the standard of care for the resection of large polyps.

OBJECTIVE: To compare the efficacy and safety profile of submucosal polidocanol injection with epinephrine-saline solution injection for colon polypectomy with a diathermic snare.

DESIGN: After 1-to-1 propensity score caliper matching, comparison of submucosal epinephrine injection was performed with polidocanol injection.

SETTING: Endoscopic suite at the University of Foggia between 2005 and 2014.

PATIENTS: Of 711 patients who underwent endoscopic resection of colon sessile polyps 20 mm or larger, 612 were analyzed after matching.

INTERVENTIONS: Submucosal epinephrine injection in 306 patients and polidocanol injection in 306 patients.

MAIN OUTCOME MEASUREMENTS: Univariate and multivariate logistic regression models aimed at identifying independent predictors of postpolypectomy bleeding (PPB).

RESULTS: The 2 groups presented similar baseline clinical parameters and lesion characteristics. All patients had a single polyp 20 mm or larger; the median size was 32 mm (interquartile range [IQR], 25-38) in the polidocanol group and 32 (IQR, 24-38) in the epinephrine group (P = .7). Polidocanol was more effective in preventing both immediate and delayed PPB (P < .001 and P = .003, respectively), and its efficacy was confirmed in almost all of the subgroups, regardless of polyp size and histology. Postprocedure perforation was observed in 2 patients (0.3%), both in the epinephrine group (P = .49). The 2 groups did not differ in the number of snare resections of lesions or the procedure duration (P = .24 and .6, respectively).

LIMITATIONS: Absence of randomization.

CONCLUSION: The submucosal injection of polidocanol for colon EMR is effective and significantly lowers the PPB rate.

PMID: 25910664 [PubMed - as supplied by publisher]

Natural language processing as an alternative to manual reporting of colonoscopy quality metrics.

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Natural language processing as an alternative to manual reporting of colonoscopy quality metrics.

Gastrointest Endosc. 2015 Apr 22;

Authors: Raju GS, Lum PJ, Slack RS, Thirumurthi S, Lynch PM, Miller E, Weston BR, Davila ML, Bhutani MS, Shafi MA, Bresalier RS, Dekovich AA, Lee JH, Guha S, Pande M, Blechacz B, Rashid A, Routbort M, Shuttlesworth G, Mishra L, Stroehlein JR, Ross WA

Abstract

BACKGROUND AND AIMS: The adenoma detection rate (ADR) is a quality metric tied to interval colon cancer occurrence. However, manual extraction of data to calculate and track the ADR in clinical practice is labor-intensive. To overcome this difficulty, we developed a natural language processing (NLP) method to identify adenomas and sessile serrated adenomas (SSAs) in patients undergoing their first screening colonoscopy. We compared the NLP-generated results with that of manual data extraction to test the accuracy of NLP and report on colonoscopy quality metrics using NLP.

METHODS: Identification of screening colonoscopies using NLP was compared with that using the manual method for 12,748 patients who underwent colonoscopies from July 2010 to February 2013. Also, identification of adenomas and SSAs using NLP was compared with that using the manual method with 2259 matched patient records. Colonoscopy ADRs using these methods were generated for each physician.

RESULTS: NLP correctly identified 91.3% of the screening examinations, whereas the manual method identified 87.8% of them. Both the manual method and NLP correctly identified examinations of patients with adenomas and SSAs in the matched records almost perfectly. Both NLP and the manual method produced comparable values for ADRs for each endoscopist and for the group as a whole.

CONCLUSIONS: NLP can correctly identify screening colonoscopies, accurately identify adenomas and SSAs in a pathology database, and provide real-time quality metrics for colonoscopy.

PMID: 25910665 [PubMed - as supplied by publisher]

Characterization and significance of protrusions in the mucosal defect after cold snare polypectomy.

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Characterization and significance of protrusions in the mucosal defect after cold snare polypectomy.

Gastrointest Endosc. 2015 Apr 22;

Authors: Tutticci N, Burgess NG, Pellise M, Mcleod D, Bourke MJ

Abstract

BACKGROUND: Cold snare polypectomy (CSP) is widely practiced; however, the endoscopic features of the CSP mucosal defect have not been studied. In particular, protrusions within the cold snare defect (CSDPs) may create concern for residual polyp. The frequency and constituents of this phenomenon are unknown.

OBJECTIVE: To describe the frequency, predictors, and histologic constituents of CSDPs.

DESIGN: Prospective observational study.

SETTING: Tertiary-care hospital endoscopy unit.

PATIENTS: Eighty-eight consecutive patients undergoing CSP for a polyp ≤ 10 mm in size.

INTERVENTION: Inspection of the cold snare mucosal defect with high-definition white light and biopsy sampling of CSDPs for separate histologic assessment, when present.

MAIN OUTCOME MEASUREMENT: Frequency and constituents of CSDPs.

RESULTS: Two hundred fifty-seven consecutive polyps ≤ 10 mm in size were removed in 88 patients (50 men [57%], mean age 63 years). Polyps were predominately adenomatous (162, 63%), located in the proximal colon (159, 62%) and flat (200, 78%). Mean lesion size was 5.5 mm (range, 2-10 mm). High-grade dysplasia was present in a single polyp for which the defect was bland. CSDPs occurred in 36 polypectomies (14%). CSDPs were associated with polyp size ≥ 6 mm (odds ratio, 3.7; P < .001 multivariable analysis) but not age, sex, lesion, histopathology, morphology, or location. Histopathologic examination of CSDPs revealed submucosa in 34 (94%) and muscularis mucosa in 29 (80%). No residual adenomatous or serrated polyp tissue was detected.

LIMITATIONS: Single-center study. Small number of polyps with high-grade dysplasia.

CONCLUSION: Protrusions are common within the CSP mucosal defect and are associated with polyp size ≥ 6 mm. CSDPs do not represent vascular structures, do not contain residual polyp, and are not associated with adverse outcomes in short-term follow-up. However, CSDPs represent incomplete mucosal layer resection.

PMID: 25910666 [PubMed - as supplied by publisher]

Radiographic staging practices of newly diagnosed colorectal cancer vary according to medical specialty.

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Radiographic staging practices of newly diagnosed colorectal cancer vary according to medical specialty.

Gastrointest Endosc. 2015 Apr 22;

Authors: Ma K, Nayak S, Li H, Evans K, Francescatti A, Brand MI, Orkin B, Hill M, Cameron J, Mobarhan S, Favuzza J, Melson J

Abstract

BACKGROUND: Since 2008, multiple guidelines have endorsed incorporation of chest CT in the radiographic staging assessment of newly diagnosed colorectal cancer (CRC). Radiographic staging practices performed after CRC is detected have not been studied.

OBJECTIVE: To evaluate radiographic staging practices for newly diagnosed CRC between gastroenterologists versus non-gastroenterologists.

DESIGN: Observational cohort study.

SETTING: Single, tertiary-care referral center.

PATIENTS: Patients newly diagnosed with a T1 or higher stage CRC at time of colonoscopy between 2008 and 2013.

INTERVENTIONS: Radiographic staging.

MAIN OUTCOME MEASUREMENTS: Radiographic preoperative staging examinations ordered by gastroenterologists in comparison to those ordered by non-gastroenterology specialists.

RESULTS: This study included 277 patients with CRC newly diagnosed by colonoscopy. There were 141 total ordering physicians (68 gastroenterologists and 73 non-gastroenterologists). The majority of preoperative radiographic staging was performed by gastroenterologists (59.2% of patients, n = 164). Colorectal surgeons managed staging in 28.7% of patients (n = 47). Gastroenterologists were more likely to omit a staging chest CT than were non-gastroenterologists (64.6% vs 46.9%; P < .001). Physician practice setting, rectal location of tumor, and advanced endoscopic appearance of tumors were predictors of chest CT inclusion.

LIMITATIONS: Single center, moderate sample size of both providers and patients.

CONCLUSION: Gastroenterologists more frequently ordered the initial radiographic staging studies in newly diagnosed CRC patients. However, gastroenterologists were less likely to include chest CT in the initial staging of CRC despite current guideline recommendations to do so. If confirmed with further studies, educational efforts to improve compliance and standardization may be needed.

PMID: 25910667 [PubMed - as supplied by publisher]