BACKGROUND The role of prophylactic clipping for the prevention of delayed polypectomy bleeding(DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection te...BACKGROUND The role of prophylactic clipping for the prevention of delayed polypectomy bleeding(DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes.AIM To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection(EMR) of colorectal lesions ≥ 20 mm.METHODS We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I^2 were used to test for heterogeneity. Pooling was conducted using a random-effects model.RESULTS Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB(1.4%) when compared to no clipping(5.2%)(pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm.There was no significant heterogeneity among the studies(I^2 = 0%, P = 0.67).CONLUSION Prophylactic clipping may reduce DPB following EMR of large colorectal lesions.Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy.展开更多
AIM To investigate the clinical, biochemical and imaging characteristics of adult cystic fibrosis(CF) patients with hepatic steatosis as compared to normal CF controls.METHODS We performed a retrospective review of ad...AIM To investigate the clinical, biochemical and imaging characteristics of adult cystic fibrosis(CF) patients with hepatic steatosis as compared to normal CF controls.METHODS We performed a retrospective review of adult CF patients in an academic outpatient setting during 2016. Baseline characteristics, genetic mutation analysis as well as laboratory values were collected. Abdominal imaging(ultrasound, computed tomography, magnetic resonance) was used to determine presence of hepatic steatosis. We compare patients with hepatic steatosis to normal controls.RESULTS Data was collected on 114 patients meeting inclusion criteria. Seventeen patients(14.9%) were found to have hepatic steatosis on imaging. Being overweight(BMI > 25)(P = 0.019) and having a higher pp FEV1(75 vs 53, P = 0.037) were significantly associated with hepatic steatosis. Patients with hepatic steatosis had a significantly higher median alanine aminotransferase level(27 vs 19, P = 0.048). None of the hepatic steatosis patients had frank CF liver disease, cirrhosis or portal hypertension. We found no significant association with pancreatic insufficiency or CF related diabetes.CONCLUSION Hepatic steatosis appears to be a clinically and phenotypically distinct entity from CF liver disease. The lack of association with malnourishment and the significant association with higher BMI and higher pp FEV1 demonstrate similarities with non-alcoholic fatty liver disease. Long term prospective studies are needed to ascertain whether CF hepatic steatosis progresses to fibrosis and cirrhosis.展开更多
BACKGROUND Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions,surgical intervention carries a much higher bleeding risk.When such lesions are discovered,endoscopic submucosal dissection...BACKGROUND Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions,surgical intervention carries a much higher bleeding risk.When such lesions are discovered,endoscopic submucosal dissection(ESD)may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic resection.AIM To evaluate the outcomes of ESD in patients with cirrhosis.METHODS Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location,size,and anticoagulation use.Procedural outcomes were compared between groups.RESULTS A total of 64 Lesions from 59 patients were included(16 cirrhosis,43 control).There were no differences in patient or lesion characteristics between groups.En bloc and curative resection was achieved in 84.21%,78.94%of the cirrhosis group and 88.89%,68.89%of controls,respectively,with no significant differences.Cirrhotic patients had significantly higher rates of intra-procedural coagulation grasper use for control of bleeding(47.37%vs 20%;P=0.02).There were otherwise no significant differences in adverse event rates.In the 29 patients with follow up,we found higher rates of recurrence in the cirrhosis group compared to controls(40%vs 5.26%;P=0.019),however this effect did not persist on multivariable analysis controlling for known confounders.CONCLUSION ESD may be safe and effective in patients with cirrhosis.Most procedure related outcomes were not significantly different between groups.Intra-procedural bleeding requiring use of the coagulation grasper use was expectedly higher in the cirrhosis group given the known effects of liver disease on hemostasis.展开更多
Background:Despitemajor advances in themedicalmanagement of Crohn’s disease(CD),a significant proportion of patients will require surgery within 5 years of diagnosis.Malnutrition is an independent risk factor for adv...Background:Despitemajor advances in themedicalmanagement of Crohn’s disease(CD),a significant proportion of patients will require surgery within 5 years of diagnosis.Malnutrition is an independent risk factor for adverse post-operative outcomes following gastrointestinal surgery.Data on the value of pre-operative total parenteral nutrition(TPN)in CD patients aremixed and there is a paucity of data in the biologic era.We aimed to define the role of pre-operative TPN in this population.Methods:This was a retrospective cohort study conducted at a tertiary referral center.CD patients who underwent major abdominal surgery were identified.Patients receiving pre-operative TPN were compared to controls.We compared the incidence of 30-day infectious and non-infectious post-operative complications between the two groups.Results:A total of 144 CD patients who underwent major abdominal surgery between March 2007 and March 2017 were included.Fifty-five patients who received pre-operative TPN were compared to 89 controls.Twenty-one(14.6%)patients developed infectious complications(18.2%in TPN group vs 12.3%in non-TPN group,P=0.34)and 23(15.9%)developed noninfectious complications(14.5%in TPN group vs 16.9%in non-TPN group,P=0.71).In a multivariate analysis,controlling for differences in baseline disease severity and malnutrition between groups,patients receiving pre-operative TPN for60 days had significantly lower odds of developing non-infectious complications(odds ratio 0.07,95%confidence interval:0.01–0.80,P=0.03).Weight loss of>10%in the past 6 months was a significant predictor of post-operative complications.Conclusions:In a subset of malnourished CD patients,TPN is safe and allows comparable operative outcomes to controls.Pre-operative TPN for60 days reduced post-operative non-infectious complications without associated increase in infectious complications.展开更多
Described as early as the 1950s(1),cholangioscopy has evolved from a burdensome intra-operative maneuver performed during open surgery,to a minimally-invasive,widely-available tool that can be utilized on demand durin...Described as early as the 1950s(1),cholangioscopy has evolved from a burdensome intra-operative maneuver performed during open surgery,to a minimally-invasive,widely-available tool that can be utilized on demand during endoscopic retrograde cholangiopancreatography(ERCP).The advent of the latest generation digital cholangioscopes with improved image quality,maneuverability,and the ability to pass tools through a dedicated instrument channel has revolutionized the modern approach to a wide variety of biliary disorders(2).展开更多
文摘BACKGROUND The role of prophylactic clipping for the prevention of delayed polypectomy bleeding(DPB) remains unclear and conclusions from prior meta-analyses are limited due to the inclusion of variety of resection techniques and polyp sizes.AIM To conduct a meta-analysis on the effect of clipping on DPB following endoscopic mucosal resection(EMR) of colorectal lesions ≥ 20 mm.METHODS We performed a search of PubMed and the Cochrane library for studies comparing the effect of clipping vs no clipping on DPB following endoscopic resection. The Cochran Q test and I^2 were used to test for heterogeneity. Pooling was conducted using a random-effects model.RESULTS Thirteen studies with a total of 7794 polyps were identified, of which data was available on 1701 cases of EMR of lesions ≥ 20 mm. Prophylactic clipping was associated with a lower rate of DPB(1.4%) when compared to no clipping(5.2%)(pooled OR: 0.24, 95%CI: 0.12-0.50, P < 0.001) following EMR of lesions ≥ 20 mm.There was no significant heterogeneity among the studies(I^2 = 0%, P = 0.67).CONLUSION Prophylactic clipping may reduce DPB following EMR of large colorectal lesions.Future trials are needed to further identify risk factors and stratify high risk cases in order to implement a cost-effective preventive strategy.
文摘AIM To investigate the clinical, biochemical and imaging characteristics of adult cystic fibrosis(CF) patients with hepatic steatosis as compared to normal CF controls.METHODS We performed a retrospective review of adult CF patients in an academic outpatient setting during 2016. Baseline characteristics, genetic mutation analysis as well as laboratory values were collected. Abdominal imaging(ultrasound, computed tomography, magnetic resonance) was used to determine presence of hepatic steatosis. We compare patients with hepatic steatosis to normal controls.RESULTS Data was collected on 114 patients meeting inclusion criteria. Seventeen patients(14.9%) were found to have hepatic steatosis on imaging. Being overweight(BMI > 25)(P = 0.019) and having a higher pp FEV1(75 vs 53, P = 0.037) were significantly associated with hepatic steatosis. Patients with hepatic steatosis had a significantly higher median alanine aminotransferase level(27 vs 19, P = 0.048). None of the hepatic steatosis patients had frank CF liver disease, cirrhosis or portal hypertension. We found no significant association with pancreatic insufficiency or CF related diabetes.CONCLUSION Hepatic steatosis appears to be a clinically and phenotypically distinct entity from CF liver disease. The lack of association with malnourishment and the significant association with higher BMI and higher pp FEV1 demonstrate similarities with non-alcoholic fatty liver disease. Long term prospective studies are needed to ascertain whether CF hepatic steatosis progresses to fibrosis and cirrhosis.
基金reviewed and approved by the Baylor College of Medicine Institutional Review Board.
文摘BACKGROUND Among patients with cirrhosis and pre-malignant or early malignant mucosal lesions,surgical intervention carries a much higher bleeding risk.When such lesions are discovered,endoscopic submucosal dissection(ESD)may offer curative therapy with lower risks than surgery and improved outcomes compared to traditional endoscopic resection.AIM To evaluate the outcomes of ESD in patients with cirrhosis.METHODS Patients with cirrhosis undergoing ESD between July 2015 and August 2022 were retrospectively matched in 1:2 fashion to controls based on lesion location,size,and anticoagulation use.Procedural outcomes were compared between groups.RESULTS A total of 64 Lesions from 59 patients were included(16 cirrhosis,43 control).There were no differences in patient or lesion characteristics between groups.En bloc and curative resection was achieved in 84.21%,78.94%of the cirrhosis group and 88.89%,68.89%of controls,respectively,with no significant differences.Cirrhotic patients had significantly higher rates of intra-procedural coagulation grasper use for control of bleeding(47.37%vs 20%;P=0.02).There were otherwise no significant differences in adverse event rates.In the 29 patients with follow up,we found higher rates of recurrence in the cirrhosis group compared to controls(40%vs 5.26%;P=0.019),however this effect did not persist on multivariable analysis controlling for known confounders.CONCLUSION ESD may be safe and effective in patients with cirrhosis.Most procedure related outcomes were not significantly different between groups.Intra-procedural bleeding requiring use of the coagulation grasper use was expectedly higher in the cirrhosis group given the known effects of liver disease on hemostasis.
文摘Background:Despitemajor advances in themedicalmanagement of Crohn’s disease(CD),a significant proportion of patients will require surgery within 5 years of diagnosis.Malnutrition is an independent risk factor for adverse post-operative outcomes following gastrointestinal surgery.Data on the value of pre-operative total parenteral nutrition(TPN)in CD patients aremixed and there is a paucity of data in the biologic era.We aimed to define the role of pre-operative TPN in this population.Methods:This was a retrospective cohort study conducted at a tertiary referral center.CD patients who underwent major abdominal surgery were identified.Patients receiving pre-operative TPN were compared to controls.We compared the incidence of 30-day infectious and non-infectious post-operative complications between the two groups.Results:A total of 144 CD patients who underwent major abdominal surgery between March 2007 and March 2017 were included.Fifty-five patients who received pre-operative TPN were compared to 89 controls.Twenty-one(14.6%)patients developed infectious complications(18.2%in TPN group vs 12.3%in non-TPN group,P=0.34)and 23(15.9%)developed noninfectious complications(14.5%in TPN group vs 16.9%in non-TPN group,P=0.71).In a multivariate analysis,controlling for differences in baseline disease severity and malnutrition between groups,patients receiving pre-operative TPN for60 days had significantly lower odds of developing non-infectious complications(odds ratio 0.07,95%confidence interval:0.01–0.80,P=0.03).Weight loss of>10%in the past 6 months was a significant predictor of post-operative complications.Conclusions:In a subset of malnourished CD patients,TPN is safe and allows comparable operative outcomes to controls.Pre-operative TPN for60 days reduced post-operative non-infectious complications without associated increase in infectious complications.
文摘Described as early as the 1950s(1),cholangioscopy has evolved from a burdensome intra-operative maneuver performed during open surgery,to a minimally-invasive,widely-available tool that can be utilized on demand during endoscopic retrograde cholangiopancreatography(ERCP).The advent of the latest generation digital cholangioscopes with improved image quality,maneuverability,and the ability to pass tools through a dedicated instrument channel has revolutionized the modern approach to a wide variety of biliary disorders(2).
