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Expert Review of Gastroenterology &... Jun 2020Benign gastrointestinal strictures are common, and can be congenital or acquired (anastomotic, corrosive, induced by Crohn's disease or endoscopic treatments, etc.)....
INTRODUCTION
Benign gastrointestinal strictures are common, and can be congenital or acquired (anastomotic, corrosive, induced by Crohn's disease or endoscopic treatments, etc.). Patients usually present with stricture-related symptoms such as vomiting, dysphagia, dyschezia, abdominal pain, which impair their quality of life. Endoscopic balloon dilation (EBD) is the first-line treatment for most of the benign strictures; however, long-term efficacy is suboptimal, and the recurrence rate can be up to 38%. Endoscopic incision (EI) was firstly reported for treatment of congenital membranous stricture, and then applied to other benign gastrointestinal strictures.
AREA COVERED
In the present review, we provided a comprehensive review of EI for the treatment of benign gastrointestinal strictures, mainly focus on the technical details, indication, safety, and efficacy of EI. The present review is expected to provide tips for operators who are going to perform EI.
EXPERT OPINION
EI can serve as an alternative method for treatment of gastrointestinal strictures, the best indications are congenital membranous stricture and short-segmental (<1 cm) anastomotic strictures refractory to EBD. EI may also be attempted for strictures induced by other reasons. Combination with other endoscopic methods such as EBD, local steroid injection, stent placement, may improve the efficacy of EI.
Topics: Constriction, Pathologic; Dilatation; Endoscopy, Gastrointestinal; Gastrointestinal Diseases; Humans; Prosthesis Implantation; Recurrence; Secondary Prevention; Stents
PubMed: 32380885
DOI: 10.1080/17474124.2020.1766966 -
The Cochrane Database of Systematic... Feb 2017Previous randomised trials and meta-analyses have shown that nasal continuous positive airway pressure (NCPAP) is a useful method for providing respiratory support after... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Previous randomised trials and meta-analyses have shown that nasal continuous positive airway pressure (NCPAP) is a useful method for providing respiratory support after extubation. However, this treatment sometimes 'fails' in infants, and they may require endotracheal re-intubation with its attendant risks and expense. Nasal intermittent positive pressure ventilation (NIPPV) can augment NCPAP by delivering ventilator breaths via nasal prongs. Older children and adults with chronic respiratory failure benefit from NIPPV, and the technique has been applied to neonates. However, serious side effects including gastric perforation have been reported with older methods of providing NIPPV.
OBJECTIVES
Primary objective To compare effects of management with NIPPV versus NCPAP on the need for additional ventilatory support in preterm infants whose endotracheal tube was removed after a period of intermittent positive pressure ventilation. Secondary objectives To compare rates of gastric distension, gastrointestinal perforation, necrotising enterocolitis and chronic lung disease; duration of hospitalisation; and rates of apnoea, air leak and mortality for NIPPV and NCPAP.
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 9), MEDLINE via PubMed (1966 to 28 September 2015), Embase (1980 to 28 September 2015) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 28 September 2015). We also searched clinical trials databases, conference proceedings and reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
SELECTION CRITERIA
We included randomised and quasi-randomised trials comparing use of NIPPV versus NCPAP in extubated preterm infants. NIPPV included non-invasive support delivered by a mechanical ventilator or a bilevel device in a synchronised or non-synchronised way. Participants included ventilated preterm infants who were ready to be extubated to non-invasive respiratory support. Interventions compared were NIPPV, delivered by short nasal prongs or nasopharyngeal tube, and NCPAP, delivered by the same methods.Types of outcomes measures included failure of therapy (respiratory failure, rates of endotracheal re-intubation); gastrointestinal complications (i.e. abdominal distension requiring cessation of feeds, gastrointestinal perforation or necrotising enterocolitis); pulmonary air leak; chronic lung disease (oxygen requirement at 36 weeks' postmenstrual age) and mortality.
DATA COLLECTION AND ANALYSIS
Three review authors independently extracted data regarding clinical outcomes including extubation failure; endotracheal re-intubation; rates of apnoea, gastrointestinal perforation, feeding intolerance, necrotising enterocolitis, chronic lung disease and air leak; and duration of hospital stay. We analysed trials using risk ratio (RR), risk difference (RD) and the number needed to treat for an additional beneficial outcome (NNTB) or an additional harmful outcome (NNTH) for dichotomous outcomes, and mean difference (MD) for continuous outcomes. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence.
MAIN RESULTS
Through the search, we identified 10 trials enrolling a total of 1431 infants and comparing extubation of infants to NIPPV or NCPAP. Three trials had methodological limitations and possible selection bias.Five trials used the synchronised form of NIPPV, four used the non-synchronised form and one used both methods. Eight studies used NIPPV delivered by a ventilator, one used a bilevel device and one used both methods. When all studies were included, meta-analysis demonstrated a statistically and clinically significant reduction in the risk of meeting extubation failure criteria (typical RR 0.70, 95% CI 0.60 to 0.80; typical RD -0.13, 95% CI -0.17 to -0.08; NNTB 8, 95% CI 6 to 13; 10 trials, 1431 infants) and needing re-intubation (typical RR 0.76, 95% CI 0.65 to 0.88; typical RD -0.10, 95% CI -0.15 to -0.05; NNTB 10, 95% CI 7 to 20; 10 trials, 1431 infants). We graded evidence for these outcomes as moderate, as all trial interventions were unblinded. Although methods of synchronisation varied (Graseby capsule or pneumotachograph/flow-trigger), the five trials that synchronised NIPPV showed a statistically significant benefit for infants extubated to NIPPV in terms of prevention of extubation failure up to one week after extubation.Unsynchronised NIPPV also reduced extubation failure. NIPPV provided via a ventilator is more beneficial than that provided by bilevel devices in reducing extubation failure during the first week. When comparing interventions, investigators found no significant reduction in rates of chronic lung disease (typical RR 0.94, 95% CI 0.80 to 1.10; typical RD -0.02, 95% CI -0.08 to 0.03) or death, and no difference in the incidence of necrotising enterocolitis. Air leaks were reduced in infants randomised to NIPPV (typical RR 0.48, 95% CI 0.28 to 0.82; typical RD -0.03, 95% CI -0.05 to -0.01; NNTB 33, 95% CI 20 to 100). We graded evidence quality as moderate (unblinded studies) or low (imprecision) for secondary outcomes.
AUTHORS' CONCLUSIONS
Implications for practice NIPPV reduces the incidence of extubation failure and the need for re-intubation within 48 hours to one week more effectively than NCPAP; however, it has no effect on chronic lung disease nor on mortality. Synchronisation may be important in delivering effective NIPPV. The device used to deliver NIPPV may be important; however, data are insufficient to support strong conclusions. NIPPV does not appear to be associated with increased gastrointestinal side effects. Implications for research Large trials should establish the impact of synchronisation of NIPPV on safety and efficacy of the technique and should compare the efficacy of bilevel devices versus a ventilator for providing NIPPV.
Topics: Dilatation, Pathologic; Enterocolitis, Necrotizing; Humans; Infant, Newborn; Infant, Premature; Intermittent Positive-Pressure Ventilation; Intubation, Intratracheal; Positive-Pressure Respiration; Randomized Controlled Trials as Topic; Respiratory Insufficiency; Retreatment; Stomach; Ventilator Weaning
PubMed: 28146296
DOI: 10.1002/14651858.CD003212.pub3 -
International Journal of Nursing Studies Dec 2019Currently the nasogastric tube (NGT) is routinely inserted in clinical after abdominal surgery for decompression in China, yet the practice varies between regions, the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Currently the nasogastric tube (NGT) is routinely inserted in clinical after abdominal surgery for decompression in China, yet the practice varies between regions, the role of NGT for the patients after hepatic surgery remains unclear. Therefore, this present meta-analysis aimed to assess the efficacy and safety of NGT placement after hepatic surgery.
DESIGN
A systematic review and meta-analysis DATA SOURCES: PUBMED, EMBASE, Science Direct, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI) and Wanfang Database (until Mar 30, 2019) were systematically searched.
REVIEW METHODS
Randomized controlled studies (RCTs) comparing the efficacy and safety of NGT and no NGT treatment after hepatic surgery were included. Data were synthesized using a random-effects or fixed effect model according to the heterogeneity. Outcomes were presented as Mantel-Haenszel style odd ratios (ORs) or mean differences (MDs) with 95% confidence intervals (95% CIs).
RESULTS
Seven studies with 1306 patients were eligible for inclusion. Compared with NGT treatment, the no NGT decompression could shorten the time to first defecation (MD -0.59; -0.79, -0.39), reduce the time to start diet (MD -0.46; -0.90, -0.03), and decrease the length of hospital stay (MD 0.48; -0.93, -0.03), but it could also increase the risk of NGT re-intubation (OR 6.8; 1.77, 26.72), no significant differences were detected on the first passage of flatus (MD -0.34; -0.86, 0.18), the incidence of nausea (OR 0.81; 0.40, 1.67), vomiting (OR 1.06; 0.19, 5.93), abdominal distention (OR 0.87; 0.60, 1.25).
CONCLUSION
Given that very limited information for some endpoints in this present meta-analysis, the routinely insertion of NGT after hepatic surgery is not justified, the no NGT decompression seems to be more beneficial to the prognosis of patients after hepatic surgery, more related studies on this issue are needed.
Topics: China; Humans; Intubation, Gastrointestinal; Liver
PubMed: 31629211
DOI: 10.1016/j.ijnurstu.2019.103406 -
The American Journal of Cardiology Feb 2019Many studies have explored the hypothesis that epicardial adipose tissue (EAT) accumulation adversely affects cardiac remodeling. We assessed, through a systematic... (Meta-Analysis)
Meta-Analysis
Many studies have explored the hypothesis that epicardial adipose tissue (EAT) accumulation adversely affects cardiac remodeling. We assessed, through a systematic review and meta-analysis, whether EAT is linked to left atrial (LA) and left ventricular (LV) structure and function, irrespective of global or abdominal visceral adiposity. We searched MEDLINE, Scopus, and Web of Science for studies evaluating the association of EAT volume quantified by computed tomography with cardiac morphology and function. We used DerSimonian and Laird random-effects models to summarize the adjusted-effect of 10 ml variation of EAT on LA size, LV mass, LV diastolic and systolic functions parameters, and presence of diastolic dysfunction. We quantified heterogeneity using I statistic. We included 19 studies. Quantitative analysis by cardiac parameters, including LA dimension (n = 2,719), LV mass (n = 2,519), diastolic function (n = 3,741), and systolic function (n = 2,037) showed that EAT was associated with LA dilation (pooled B-coefficient: 0.12 mm; 95% confidence interval [CI] 0.08 to 0.17; I: 97%), LV hypertrophy (pooled B-coefficient: 1.21 g; 95% CI 0.63 to 1.79; I: 77%), diastolic dysfunction (odds ratio: 1.35; 95% CI 1.16 to 1.57; I: 0%), higher E/E' ratio (pooled B-coefficient: 0.28 cm/s; 95% CI 0.08 to 0.49; I: 67%), lower E' velocity (pooled B-coefficient: -0.16 cm/s; 95% CI -0.22 to -0.09; I: 43%), and E/A ratio (pooled B-coefficient: -0.01; 95% CI -0.02 to -0.001; I: 70%), independently of body mass index. There was no association between EAT and LV systolic function. In conclusion, EAT volume measured by computed tomography was independently associated with LA dilation, LV hypertrophy, and diastolic dysfunction.
Topics: Adipose Tissue; Blood Flow Velocity; Diastole; Dilatation, Pathologic; Heart Atria; Humans; Hypertrophy, Left Ventricular; Pericardium; Tomography, X-Ray Computed
PubMed: 30477802
DOI: 10.1016/j.amjcard.2018.10.020 -
Annals of Palliative Medicine Apr 2021Moxibustion is widely used in the recovery of gastrointestinal function in East Asian countries, especially in China. This systematic review aims to evaluate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Moxibustion is widely used in the recovery of gastrointestinal function in East Asian countries, especially in China. This systematic review aims to evaluate the recovery effects of moxibustion on gastrointestinal function in preventing early postoperative small-bowel obstruction (EPSBO).
METHODS
The Medline, Embase, PubMed, and the other seven databases were searched independently by two authors. Randomized controlled trials (RCTs) were selected using the PICOS method. The methodological quality was appraised with the Cochrane's risk of bias tool, and the reporting quality of included studies was evaluated by Consolidated Standards of Reporting Trials (CONSORT) and STandards for Reporting Interventions in Clinical Trials of Moxibustion (STRICTOM), respectively. Revman 5.2.0 was used for statistical analysis, and the mean difference (MD) with 95% confidence interval (CI) was performed for effect estimation. Random effects model (REM) and fixed effects model (FEM) were used for pooling data.
RESULTS
A total of 8 RCTs with 693 participants were included. Meta-analysis showed that moxibustion combined with usual care had favorable effects on the time to first flatus (MD -15.15 h, 95% CI: -19.14 to -11.15, 8 studies, I2=85%, P<0.00001, REM), the time to bowel sound recovery (MD -10.35 h, 95% CI: -11.65 to -9.06, 7 studies, I2=0%, P=0.91, FEM), the time to first defecation (MD -18.94 h, 95% CI: -24.53 to -13.36, 3 studies, I2=45%, P=0.16, FEM), and the duration time to abdominal distention (MD -11.7 h, 95% CI: -15.32 to -8.09, 3 studies, I2=0%, P=0.70, FEM) when compared to the controls. No adverse events were reported in the included studies.
CONCLUSIONS
Moxibustion may have a beneficial effect on the recovery of gastrointestinal function in preventing EPSBO. However, positive findings should be treated carefully. And rigorous studies with high quality and large samples are warranted.
Topics: China; Humans; Moxibustion; Postoperative Complications; Recovery of Function
PubMed: 33691449
DOI: 10.21037/apm-20-1266 -
Frontiers in Medicine 2024It remains uncertain if the addition of () to bismuth quadruple therapy (BQT) recommended in the current guidelines can enhance the () eradication rate and decrease...
BACKGROUND AND OBJECTIVE
It remains uncertain if the addition of () to bismuth quadruple therapy (BQT) recommended in the current guidelines can enhance the () eradication rate and decrease the incidence of adverse events. We therefore conducted a meta-analysis of randomized controlled trials (RCTs) to address this issue.
METHODS
We performed comprehensive searches in PubMed, Embase, Web of Science, and Cochrane library databases from the inception of the databases through to November 1, 2023. A meta-analysis was conducted to determine the pooled relative risk (RR) with 95% confidence intervals (CI) using a random-effects model. We utilized the revised Cochrane Risk of Bias Tool to assess the risk of bias of included studies.
RESULTS
A total of six RCTs (1,404 patients) included in this meta-analysis. The results of the intention-to-treat analysis showed that the combination of with BQT had a higher eradication rate than BQT alone (87.0% versus 83.3%), with a pooled RR of 1.05 (95% CI: 1.00-1.10, = 0.03). In the per-protocol analysis, however, there was no statistical significance between the two groups in the eradication rate (93.7% versus 91.0%, RR = 1.03, 95% CI: 1.00-1.06, = 0.07). The combination of and BQT had a significantly lower rate of overall adverse events (22% vs. 39%, RR = 0.56, 95% CI: 0.44-0.70, < 0.00001), diarrhea (7.9% vs. 25.7%, RR = 0.29, 95% CI: 0.17-0.48, < 0.00001), constipation (2.9% vs. 8.4%, RR = 0.35, 95% CI: 0.14-0.88, = 0.03) and abdominal distention (4.9% vs. 12.7%, RR = 0.41, 95% CI: 0.23-0.72, = 0.002) than BQT alone. For the assessment of risk of bias, five studies were deemed to have some concerns, while one study was judged to have a low risk.
CONCLUSION
Current evidence suggests that supplementation with in BQT may not have a major effect on the eradication rate, but significantly reduces the incidence of overall adverse events, diarrhea, abdominal distention and constipation. Combining with BQT can help alleviate symptoms, potentially improving patient adherence.
SYSTEMATIC REVIEW REGISTRATION
https://osf.io/n9z7c.
PubMed: 38695028
DOI: 10.3389/fmed.2024.1344702 -
Rheumatology International Nov 2015Granulomatosis with polyangiitis (GPA), formerly called Wegener's Granulomatosis, is characterized by necrotizing granulomatous inflammation and belongs to the family of... (Review)
Review
Granulomatosis with polyangiitis (GPA), formerly called Wegener's Granulomatosis, is characterized by necrotizing granulomatous inflammation and belongs to the family of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. The main clinical symptoms of GPA are vasculitis primarily involving upper and lower respiratory tracts, as well as kidneys. Gastrointestinal manifestations of GPA are less common (0-20 %), with gastric presentation mimicking a gastric cancer as an initial symptom. This is a descriptive case report of one patient, together with systematic review of the literature. We described a 31-year-old Chinese woman who presented with complaints of abdominal distention, anorexia for 2 months. Gastroscopy was carried out for three times, and stomach cancer was suspected. However, histopathology of gastric biopsy revealed a chronic inflammation with mucosal ulceration, frequent neutrophils and lymphocytes infiltration, and local granulomatous formation, whereas no sign of stomach carcinoma was observed. In view of the positive cANCA test, a diagnosis of GPA was considered. From the onset of the GPA in the patients, no other organs have been involved in the disease. The patient was successfully treated with corticosteroids and cyclophosphamide. As shown in the report, patients who present only with gastrointestinal manifestations represent challenges to diagnosis. ANCA testing can serve as a decisive diagnostic tool. Although uncommon, GI involvement may be a major feature in GPA, sometimes presenting as gastric tumor-like lesions. Diagnosis should be considered in patients presenting with GI symptoms accompanied by evidence of systemic vasculitis, and ANCA test should be used as a diagnostic measurement to clarify differential diagnosis.
Topics: Adrenal Cortex Hormones; Adult; Antibodies, Antineutrophil Cytoplasmic; Biomarkers; Biopsy; Diagnosis, Differential; Female; Gastroscopy; Granulomatosis with Polyangiitis; Humans; Immunosuppressive Agents; Predictive Value of Tests; Stomach Diseases; Stomach Neoplasms; Treatment Outcome
PubMed: 26248531
DOI: 10.1007/s00296-015-3334-x -
Frontiers in Pediatrics 2021Carbon dioxide (CO) insufflation during gastrointestinal (GI) endoscopic procedures has gained popularity in adults. However, its utility in pediatric patients is not...
Carbon dioxide (CO) insufflation during gastrointestinal (GI) endoscopic procedures has gained popularity in adults. However, its utility in pediatric patients is not known. The current review aimed to compare the efficacy of CO vs. air insufflation for GI endoscopic procedures in pediatric patients. The electronic databases of PubMed, Embase, Scopus, and CENTRAL were searched from the inception of databases to 15th August 2020. All randomized controlled trials (RCTs) comparing CO vs. air insufflation for GI endoscopic procedures in pediatric patients were eligible for inclusion. Five RCTs were identified. Pooled analysis of data from 226 patients in the CO group and 224 patients in the air group revealed that patients receiving CO insufflation were at a lower odds of experiencing postoperative pain as compared to those undergoing the procedure with air (OR: 0.40; 95% CI: 0.19, 0.87; = 62%; = 0.02). Descriptive analysis indicated no difference in the two groups for abdominal distention after the procedure. Two trials reported elevated CO in the study group but without any pulmonary complications. Bloating was reported by two studies and both reported significantly less bloating in the CO group. Our study indicates that the incidence of pain may be reduced with the use of CO insufflation in pediatric GI endoscopies without a significant risk of adverse events. However, current evidence is from a limited number of trials and not strong to recommend a routine of CO in pediatric gastroenterology practice. Further high-quality RCTs are required to supplement current evidence.
PubMed: 33634056
DOI: 10.3389/fped.2021.610066 -
Journal of Gastrointestinal Cancer Jun 2024This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of perioperative or postoperative probiotics as a... (Meta-Analysis)
Meta-Analysis
Perioperative or Postoperative Probiotics Reduce Treatment-Related Complications in Adult Colorectal Cancer Patients Undergoing Surgery: A Systematic Review and Meta-analysis.
PURPOSE
This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of perioperative or postoperative probiotics as a therapeutic approach for managing colorectal cancer treatment-related complications in patients undergoing surgery, with or without adjuvant therapy.
METHODS
MEDLINE, Embase, and Scopus databases were searched.
RESULTS
Ten RCTs with 1276 patients were included. There was a significant decrease in the incidence of diarrhea (odds ratio (OR) 0.42; 95% CI 0.31 to 0.55; p < 0.001), surgical site infection (OR 0.44; 95% CI 0.22 to 0.89; p = 0.023), urinary infection (OR 0.43; 95% CI 0.20 to 0.91; p = 0.028), pulmonary infection (OR 0.30; 95% CI 0.15 to 0.60; p < 0.001), abdominal distention (OR 0.43; 95% CI 0.25 to 0.76; p = 0.004), length of ATB therapy (mean difference (MD) - 1.66 days; 95% CI - 2.13 to - 1.19 days; p < 0.001), and duration of postoperative pyrexia (MD - 0.80 days; 95% CI - 1.38 to - 0.22 days; p = 0.007) in the probiotic group. Nevertheless, length of hospital stay, time to first defecation, and time to first solid diet were not different between groups.
CONCLUSION
Our findings suggest that perioperative or postoperative probiotics is effective for reducing treatment-related complications in patients with colorectal cancer undergoing surgery, with a lower rate of adverse events.
Topics: Humans; Probiotics; Colorectal Neoplasms; Postoperative Complications; Perioperative Care; Randomized Controlled Trials as Topic; Adult
PubMed: 38231290
DOI: 10.1007/s12029-024-01016-8