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Gut and Liver Sep 2023The combinatorial effects of prophylactic methods for postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) in patients with risk factors remain unclear.... (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIMS
The combinatorial effects of prophylactic methods for postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) in patients with risk factors remain unclear. In this network meta-analysis, we compared the efficacy of various prophylactic strategies to decrease the risk of PEP among patients with risk factors.
METHODS
A systematic review was performed to identify randomized controlled trials from PubMed, Embase, and the Cochrane Library through July 2021. We used frequentist network meta-analysis to compare the rates of PEP among patients who received prophylactic treatments as follows: class A, rectal nonsteroidal anti-inflammatory drugs; class B, prophylactic pancreatic stent; class C, aggressive hydration; or control, no prophylaxis or active control. We selected those studies that included patients with risk factors for PEP.
RESULTS
We identified 19 trials, comprising 4,328 participants. Class ABC (odds ratio [OR], 0.08; 95% confidence interval [CI], 0.03 to 0.24), class AC (OR, 0.10; 95% CI, 0.02 to 0.47), class AB (OR, 0.12; 95% CI, 0.05 to 0.26), class BC (OR, 0.13; 95% CI, 0.04 to 0.41), class A (OR, 0.16; 95% CI, 0.05 to 0.50), and class B (OR, 0.26; 95% CI, 0.14 to 0.46), were associated with a reduced risk of PEP as compared to that of the control. The most effective prophylaxis was ABC (0.87), followed by AC (0.68), AB (0.65), BC (0.56), A (0.49), and B (0.24) according to P-score.
CONCLUSIONS
The results of this network meta-analysis suggest that the more prophylactic methods are employed, the better the outcomes. It appears that for patients with risk factors, we need to prevent PEP through the use of these well proven combination strategies.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Network Meta-Analysis; Pancreatitis; Anti-Inflammatory Agents, Non-Steroidal; Pancreas; Risk Factors
PubMed: 36510779
DOI: 10.5009/gnl220268 -
Endoscopy International Open Mar 2024Noninvasive ampullary neoplasms may be removed by surgery or endoscopy. However, given the morbidity and mortality associated with surgery, endoscopic papillectomy (EP)...
Noninvasive ampullary neoplasms may be removed by surgery or endoscopy. However, given the morbidity and mortality associated with surgery, endoscopic papillectomy (EP) is the preferred approach. Radiofrequency ablation (RFA) after EP has emerged as a promising alternative therapy to avoid surgery after incomplete EP. Our goal was to evaluate the efficacy and safety of RFA for residual or recurrent lesions with intraductal extension after endoscopic papillectomy. The inclusion criteria include clinical trials, cohort studies, and case series evaluating patients with residual or recurrent lesions with intraductal extension after EP treated with RFA. Case reports, duplicated data, and studies with follow-up periods < 10 months were excluded. The metanalysis evaluated adverse events, surgical conversion rate, clinical success and recurrence. Seven studies were selected, totaling 124 patients. RFA was associated with a clinical success rate of 75.7% (95% confidence interval [CI] 65.0-88.0%; I = 23.484) in a mean follow-up period < 10 months. However, the biliary stricture rate was 22.2% (95% CI 12.1-28.4%; I = 61.030), 14.3% of pancreatitis (95% CI 8.8-22.3%; I < 0.001), 7.0% of cholangitis (95% CI 3.3-14.5%; I < 0.001), 4.0% of bleeding (95% CI 1.7-9.3%; I < 0.001), and recurrence of 24.3% (95% CI 16.0-35.0%; I = 23.484). RFA is feasible and appears to be effective for managing residual or recurrent lesions with intraductal extension after EP. However, long-term follow-up and high-quality studies are required to confirm our findings.
PubMed: 38550766
DOI: 10.1055/a-2226-0928 -
Frontiers in Medicine 2024This study aimed to systematically evaluate the efficacy and safety of the double-guidewire technique along with other methods (persistent standard cannulation...
OBJECTIVE
This study aimed to systematically evaluate the efficacy and safety of the double-guidewire technique along with other methods (persistent standard cannulation techniques, transpancreatic sphincterotomy, and pancreatic stent-assisted technique) for difficult biliary cannulation.
METHODS
Two researchers searched for literature on the efficacy and safety of the double-guidewire technique and other techniques in difficult biliary cannulation in databases, including PubMed, Embase, Cochrane, China National Knowledge Infrastructure, and Wanfang Data, based on the inclusion and exclusion criteria. The success rate of cannulation, duration of cannulation, post-ERCP pancreatitis, and overall postoperative complications were also analyzed using RevMan 5.4 software.
RESULTS
In total, 20 randomized controlled trial (RCT) studies involving 2008 participants were identified. The success rate of cannulation in the double-guidewire technique was much higher than that in persistent standard cannulation techniques [RR = 1.37, 95%CI (1.05, 1.79), = 0.02]. However, it was lower than the success rate observed with transpancreatic sphincterotomy [RR = 0.89, 95%CI (0.81, 0.97), = 0.01]. There was no significance in post-ERCP pancreatitis [RR = 1.09, 95% CI (0.85, 1.40), = 0.49], overall postoperative complications [RR = 0.90, 95% CI (0.56, 1.45), = 0.66], and duration of cannulation [SMD = -0.14, 95%C I (-1.43, 1.15), = 0.83] between the double-guidewire technique and other techniques.
CONCLUSION
This study demonstrated that the success rate of cannulation ranged from transpancreatic sphincterotomy to the double-guidewire technique and then to persistent standard cannulation techniques.
PubMed: 38716417
DOI: 10.3389/fmed.2024.1344644 -
Journal of Gastrointestinal and Liver... Mar 2024Exocrine pancreatic insufficiency (EPI) is frequently described as underscreened, underdiagnosed, and undertreated. The treatment for EPI is pancreatic enzyme...
Exocrine pancreatic insufficiency (EPI) is frequently described as underscreened, underdiagnosed, and undertreated. The treatment for EPI is pancreatic enzyme replacement therapy (PERT), which is costly, and provider confidence in prescribing may be one barrier to reducing undertreatment. The lack of interchangeability studies for prescription PERT and/or lack of efficacy studies of over-the-counter enzyme options may be another barrier. This paper reviewed the prevalence of EPI in the general population and in co-conditions. Prevalence of EPI in the general population is commonly estimated around 10-20%, and further research is needed to evaluate EPI across all age groups and to better understand in which age group EPI becomes more prevalent, as an age effect is often seen in EPI prevalence studies. EPI is perceived to be highly correlated with certain co-conditions, and the majority (~65%) of EPI literature is related to a co-condition such as cystic fibrosis, pancreatitis, post-surgery, cancer, or diabetes. It can be estimated that 85% of literature in identified co-conditions, or 56% of total EPI literature, is on rarer co-conditions which only represent <1% of EPI overall. In contrast, there is very little research and literature on EPI in the general population. The highest absolute rates of EPI with co-conditions are likely diabetes and possibly irritable bowel syndrome with diarrhea, yet they are among the least commonly researched in co-condition and EPI studies. A lack of research on EPI in the general population and in the more common co-conditions may be contributing to the rates of underdiagnosis and underscreening, as well as undertreatment for those with low fecal elastase-1 levels.
Topics: Humans; Prevalence; Exocrine Pancreatic Insufficiency; Pancreas; Pancreatitis; Enzyme Replacement Therapy; Diabetes Mellitus
PubMed: 38386889
DOI: 10.15403/jgld-5005 -
Gastrointestinal Endoscopy Apr 2024Patient-Derived Tumor Organoids (PDTOs) is a promising new disease model in pancreatic cancer for use in personalized medicine, but overall success rate (SR) of...
BACKGROUND AND AIMS
Patient-Derived Tumor Organoids (PDTOs) is a promising new disease model in pancreatic cancer for use in personalized medicine, but overall success rate (SR) of establishing these cultures from endoscopic ultrasound-guided biopsies is unknown.
METHODS
We searched relevant databases publications reporting SR of PDTO establishment from pancreatic cancer. The primary outcome was SR stratified on tissue acquisition method (EUS-guided biopsies, percutaneous biopsies, and surgical specimens).
RESULTS
We identified 24 studies including 1,053 attempts at establishing PDTOs. Overall SR was 63% (95% CI: 54%-72%). Pooled SR of PDTO establishment from EUS-guided biopsies, percutaneous biopsies, and surgical specimens were 60% (95% CI: 43-76%), 36% (95% CI: 14-61%) and 62% (95% CI: 48-75%), respectively and did not differ significantly (p = 0.1975).
CONCLUSION
The SR of PDTO establishment from EUS-guided biopsies is comparable to surgical specimens. Both techniques are suitable for tissue acquisition for PDTOs in clinical and research settings.
PubMed: 38593932
DOI: 10.1016/j.gie.2024.04.012