Journal of Digestive Endoscopy最新文献

{"title":"Rotational Thromboelastometry Reduces Fresh Frozen Plasma Requirement in Patients without Liver Disease Undergoing Therapeutic Endoscopic Procedures with Deranged Screening Coagulation Tests—A Pilot Study","authors":"P. K. Bharadwaj, E. Simon, R. Dave, T. Geevar, Sukesh Nair, A. Abraham, A. J. Joseph, A. Dutta, S. Chowdhury, Rajeeb Jaleel, Anoop John, Ajith Thomas, DM George Simon","doi":"10.1055/s-0043-1776714","DOIUrl":"https://doi.org/10.1055/s-0043-1776714","url":null,"abstract":"Abstract Background/Aims  Rotational thromboelastometry (ROTEM) is a viscoelastic test that is used in patients with liver disease for guiding blood component use. This study is aimed at comparing the amount of blood products transfused and bleeding rates in patients without liver disease, who underwent therapeutic endoscopic procedures with deranged screening coagulation tests (prothrombin time [PT]; activated partial thromboplastin time [aPTT]), with and without hypocoagulable ROTEM. Methods  Patients with deranged PT and aPTT without liver disease who underwent therapeutic endoscopic interventions during the period 2020 to 2022 were retrospectively analyzed. Baseline parameters, amount of blood products transfused, and outcomes such as 30-day bleeding and mortality rates were recorded in those with and without hypocoagulable ROTEM. Results  Of the 204 patients with deranged PT/aPTT who underwent therapeutic endoscopy during the study period, 180 of those with liver disease were excluded. Six patients (M:F = 5:1; median age: 37, 20–54 years) had hypocoagulable ROTEM and 18 patients (M:F = 11:7; median age: 56, 20–71 years) had normo-/hypercoagulable ROTEM. There were significant differences in the total amount of fresh frozen plasma (FFP) transfused and FFP transfused per patient between the two groups (9,000 vs. 4,500 mL and 2,000 vs. 1,000 mL; p  = 0.04, respectively). Two patients with hypocoagulable ROTEM bled within 30 days, while none did in the comparator group ( p  = 0.03). One patient in the hypocoagulable group died within 30 days and none in the normo-/hypercoagulable group. Conclusion  The use of ROTEM reduces FFP requirement in patients without liver disease with deranged PT/aPTT undergoing therapeutic endoscopic procedures without any increased risk of early or late rebleeding, and 30-day mortality.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"67 9","pages":"191 - 196"},"PeriodicalIF":0.7,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139275754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmentally Sustainable Endoscopy Practices","authors":"Mayank Jain","doi":"10.1055/s-0043-1775873","DOIUrl":"https://doi.org/10.1055/s-0043-1775873","url":null,"abstract":"Abstract Climate change affects each and every one of us and has far reaching consequences. As healthcare providers and responsible citizens, it is our duty to make our practices environmentally sustainable. Endoscopy practice involves frequent use of single-use items, resource-heavy decontamination practices, water consumption, patient and staff travel as well as high electricity consumption. The present review highlights the measures that can be taken to reduce the carbon footprint of endoscopy practice. Proper waste management, judicious use of electricity, proper selection of cases for anesthesia and biopsy, and appropriate use of noninvasive tests in practice are discussed in the review.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"279 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135044458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Over-the-Scope Clips Compared to Standard Therapy for Nonvariceal Upper Gastrointestinal Bleeding—A Systematic Review and Meta-analysis of Randomized Trials","authors":"Suprabhat Giri, Sidharth Harindranath, Marko Kozyk, Aditya Kale, Vaneet Jearth, Sridhar Sundaram","doi":"10.1055/s-0043-1774773","DOIUrl":"https://doi.org/10.1055/s-0043-1774773","url":null,"abstract":"Abstract Background The current standard of treatment for nonvariceal upper gastrointestinal bleeding (NVUGIB) includes endoscopic hemostasis with either through-the-scope clips or thermal therapy. However, they may be associated with rebleeding, especially in high-risk ulcers. Over-the-scope clips (OTSC) have been demonstrated in multiple recent studies to be an effective measure for NVUGIB. We aimed to analyze the current literature on standard therapy with OTSC to manage NVUGIB. Methods A meta-analysis was performed by pooling the data from randomized studies obtained from a comprehensive search of Medline, Embase, and Scopus from inception to February 2023. The outcomes analyzed included rates of persistent bleeding, rebleeding, mortality, and duration of hospitalization. Results A total of five studies were included in the final analysis. There was no significant difference in the risk of persistent bleeding between the groups, with a risk ratio (RR) of 0.29 (95% confidence interval [CI]: 0.07–1.27). The use of OTSC was associated with a significantly lower risk of 7-day and 30-day rebleeding compared with standard therapy with RR of 0.30 (95% CI: 0.16–0.59) and 0.42 (95% CI: 0.24–0.72), respectively. There was no difference in the risk of 30-day mortality or the duration of hospitalization. There was no change in the effect on subgroup analysis of studies using OTSC as first-line therapy. Conclusion The use of OTSC can reduce the rebleeding rates after endoscopic hemostasis. However, they may not reduce the risk of persistent bleeding or mortality. Future studies are required on the cost-efficacy of this modality.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135044457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Endoscopic Transmural Drainage for Pancreatic Necrosis: Expanding the Horizon!","authors":"Surinder Singh Rana","doi":"10.1055/s-0043-1775758","DOIUrl":"https://doi.org/10.1055/s-0043-1775758","url":null,"abstract":"Abstract Endoscopic transluminal drainage (ETD) has been traditionally performed on collections that have a well-formed enclosing wall and therefore it was advocated for walled-off necrosis. However, recently, retrospective studies have reported that ETD can be safely performed in patients with collections without a well-formed wall also and reported outcomes better than those patients who were treated with percutaneous drainage. The evidence for safety and efficacy of early ETD for infected pancreatic necrosis is scanty and therefore, in this news and views, I will be discussing a recently published systematic review and meta-analysis comparing outcomes after early (<4 weeks) and standard (≥4 weeks) drainage of pancreatic necrosis.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135345250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Submucosal Dissection for Early Gastric Cancer in A Cirrhotic Patient: Case Report and Review of Literature","authors":"Unique Tyagi, Sridhar Sundaram, Aadish Kumar Jain, Akhil Mahajan, Rahul Puri, Prachi Patil, Shaesta Mehta","doi":"10.1055/s-0043-1773773","DOIUrl":"https://doi.org/10.1055/s-0043-1773773","url":null,"abstract":"Abstract Endoscopic resection techniques like endoscopic mucosal resection and endoscopic submucosal dissection have become the cornerstone for the management of early cancers of the gastrointestinal tract. Risks associated with endoscopic resection may be exacerbated by the presence of background cirrhosis with its attendant complications. With complex alterations in hemostasis in patients with cirrhosis, management of patients undergoing endoscopic resection is more challenging. In this article we discuss a case of early gastric cancer in a patient with background chronic liver disease and thrombocytopenia managed using endoscopic submucosal dissection.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135344701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Small Bowel Capsule Endoscopy: Benefits of Rereading Rather than Repeating – a Single Blinded Randomized Study","authors":"Alamir-Noureddine AlAyoubi, Ayman Tabcheh, Nourhane Obeid, Antoine Challita, Judy Matta, Said Farhat","doi":"10.1055/s-0043-1774807","DOIUrl":"https://doi.org/10.1055/s-0043-1774807","url":null,"abstract":"Abstract Introduction Small bowel capsule endoscopy (SBCE) technology detects small bowel lesions. Many factors affect its sensitivity. SBCE is also costly, and patients might not be able to repeat the test when results are equivocal. Instead of repeating the test, reading the results by two endoscopists might provide a better or a cheaper option in the right settings. We studied the sensitivity of SBCE when read by two different physicians and checked if, rather than repeating the examination, rereading the results improved its sensitivity. Furthermore, we studied the effect of small bowel transit time (SBTT) on the diagnostic yield. Methods A retrospective cohort study on capsule endoscopies was conducted between 2018 and 2019 in a tertiary care center in Lebanon. A total of 42 patients with anemia or obscure gastrointestinal bleed were included for SBCE after a negative evaluation with upper and lower gastrointestinal (GI) endoscopy. Two specialists read the results. The second physician was blinded from the first reader's results. We compared the sensitivity of the two readings. SBTT correlation with the diagnostic yield was calculated. Results Out of 42 patients, 18 tested positive in the first reading and 31 in the second reading. The diagnostic yield increased from 43 to 74% (p = 0.0043). Among the 33 patients who had a documented SBTT, longer SBTT correlated with a higher diagnostic yield (odds ratio [OR] &gt; 1), but no statistical significance was demonstrated. Conclusion Within the limitations of this study, we found that rereading capsule endoscopy can be more cost-effective than repeating the test.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136015036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Capsule Endoscopy in Inflammatory Bowel Disease: A Systematic Review","authors":"Partha Pal, Rupa Banerjee, Rajesh Gupta, Palle Manohar Reddy, D Nageshwar Reddy, Manu Tandan","doi":"10.1055/s-0043-1766122","DOIUrl":"https://doi.org/10.1055/s-0043-1766122","url":null,"abstract":"Abstract The role of video capsule endoscopy (VCE) in inflammatory bowel disease (IBD) has evolved from small bowel to a panenteric evaluation tool over the past two decades. We systematically reviewed the techniques, applications, outcomes, and complications of VCE in IBD. A systematic literature search was performed using PubMed, Embase, and Medline. All relevant original articles involving VCE in IBD were included from 2003 to July 2022. After screening 3,089 citations, finally 201 references were included. The diagnostic yield of VCE in suspected Crohn's disease (CD) was highly variable (6–80%) with excellent sensitivity (77–93%) and specificity (80–89%). The diagnostic yield in known CD was 52 to 88.3% leading to a change in management (26–75%) and disease reclassification with variable retention rates. VCE was superior to small bowel series, computed tomography (CT) and could be better than magnetic resonance enterography (MRE), especially for proximal and superficial lesions. Colon or panenteric VCE has strong correlation to ileo-colonoscopy (IC) and combined magnetic resonance imaging and IC, respectively. The VCE retention rate in CD is higher in known CD which significantly decreases after the negative patency capsule test or CT/MRE. VCE can identify lesions beyond the reach of IC in postoperative CD. Colon Capsule Endoscopy is a noninvasive monitoring tool in ulcerative colitis (UC) having a strong correlation with IC and may uncover small bowel involvement. VCE is specifically useful in IBD-unclassified (IBD-U) which can lead to the diagnosis of CD in 16.7 to 61.5%. Various scoring systems have been established and validated for small bowel CD (Lewis score and capsule endoscopy CD activity index—CECDAI), UC (capsule scoring of UC: Capsule Scoring of Ulcerative Colitis), panenteric evaluation (Capsule Endoscopy Crohn's Disease Activity Index, Elaikim score), and flare prediction (APEX score). Technological advances include double head, three-dimensional reconstruction, sampling system, panoramic view (344 and 360 degree lateral), and panenteric capsule. Artificial intelligence and software like TOP100 and Quickview can help reduce capsule reading time with excellent sensitivity and specificity. VCE in IBD has widespread application in suspected and known small bowel CD, monitoring of UC, postoperative CD, IBD-U, and for panenteric evaluation. Patency capsule testing helps to reduce retention rates significantly. Artificial intelligence and technical advances can help evolve this novel technology.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135735327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical, Endoscopic, and Histologic Characteristics of Patients with Solitary Rectal Ulcer Syndrome at a Tertiary Care Center","authors":"Syed Shafiq","doi":"10.1055/s-0043-1770922","DOIUrl":"https://doi.org/10.1055/s-0043-1770922","url":null,"abstract":"Abstract Objective Solitary rectal ulcer syndrome (SRUS) is a chronic disorder of defecation presenting with bleed per rectum, mucorrhea, tenesmus, perianal discomfort, etc. We aim to report clinical, endoscopic, and histologic features of SRUS in patients who underwent either colonoscopy or sigmoidoscopy at our center. Materials and Methods We performed retrospective analysis of all patients diagnosed with SRUS on endoscopy and confirmed by histopathologic examination at our center between January 2010 and June 2022. Data retrieved included demographic details, clinical features along with endoscopic, and histopathological findings of SRUS patients. Results The study included 132 patients with SRUS with mean (± standard deviation) age of 45 (± 20.6) years and male to female ratio of 1.5:1. While most of the patients presented with a combination of symptoms, the most common clinical presentation was bleeding per rectum (82%). Rectal ulcers, either single or multiple, were the predominant findings on endoscopy followed by polypoidal lesions. Histology showed fibromuscular obliteration and crypt distortion in all patients. Biofeedback training, lifestyle changes, and sucralfate enema were successful in about 87% of the patients at the end of 6 weeks and about 76% at the end of 12 weeks with surgery for rectal prolapse being performed in two of our patients. Conclusion SRUS presents with a myriad of symptoms and requires a high index of suspicion by the treating physician(s). While the most common presenting symptom in our study was rectal bleed rectal bleed; ulcers, either solitary or multiple, ulcers, either solitary or multiple, were the commonest endoscopy findings. Endoscopic findings along with histopathology confirm the diagnosis.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135735328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Endoscopic Biliary Drainage in Postsurgical Anatomy Using Endoscopic Ultrasound and Enteroscopy: A Comparative Study","authors":"Kapil Dev Jamwal, Atul Sharma, Rajesh Kumar Padhan, Manoj Kumar Sharma","doi":"10.1055/s-0043-1775861","DOIUrl":"https://doi.org/10.1055/s-0043-1775861","url":null,"abstract":"Abstract Objectives Biliary obstruction is a common problem encountered in postsurgical anatomy, which may lead to serious complications if not treated promptly. Endoscopic drainage is a minimally invasive and effective treatment option for such patients. However, the optimal route of endoscopic drainage, either SBE-ERCP (single-balloon enteroscopy with endoscopic retrograde cholangiopancreatography) or EUS-BD (endoscopic ultrasound-guided bile duct drainage), remains controversial. In this study, we aim to evaluate the feasibility and outcomes of endoscopic drainage using these two techniques in postsurgical biliary obstruction over a period of 7 years. Materials and Methods We conducted a retrospective study of patients who underwent endoscopic drainage for postsurgical biliary obstruction using SBE-ERCP or EUS-BD techniques between 2015 and 2022. The demographic details, clinical presentation, procedure duration, number of sessions required, technical success, complications, and change of procedure from SBE-ERCP to EUS-BD or vice versa were recorded. Results Seventy-five patients, predominantly females with a mean age of 48 years, underwent endoscopic drainage. Forty-eight patients underwent SBE drainage and 27 patients underwent EUS-HG (EUS-guided hepaticogastrostomy). The mean duration of procedure (44 vs. 77 minutes), number of complications (4 vs. 5), technical success rate (93.5 vs. 85%), change of procedure (0 vs. 3), and number of sessions (1.1 vs. 1.8) were significantly less in the EUS-HG as compared to SBE-ERCP. Conclusions Endoscopic biliary drainage is feasible, safe, and effective in postsurgical biliary anatomy but requires high technical expertise. The study proposes an algorithm that can be applied in such group of patients to determine the route for choosing the drainage procedure. This requires further validation with a large prospective cohort.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135735329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Presentation of Accidental Rectal Corrosive Injury","authors":"Maitrey Patel, Rushil Solanki, Radhika Chavan, Sanjay Rajput","doi":"10.1055/s-0043-1775852","DOIUrl":"https://doi.org/10.1055/s-0043-1775852","url":null,"abstract":"Abstract Rectal corrosive injuries occur rarely among adult patients and are confined to suicidal patients and cases of homicide. These injuries are less frequently accidental. No reports of rectal corrosive injury have been reported in the literature to date. In this study, we report an unusual presentation of a very rare case of accidental rectal corrosive injury.","PeriodicalId":43098,"journal":{"name":"Journal of Digestive Endoscopy","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135735943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}