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Best Practice & Research. Clinical... Dec 2023Predictive models (PMs) in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) have the potential to improve patient outcomes, enhance... (Review)
Review
Predictive models (PMs) in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) have the potential to improve patient outcomes, enhance diagnostic accuracy, and guide therapeutic interventions. This review aims to summarize the current state of predictive models in ERCP and EUS and their clinical implications. To be considered useful in clinical practice a PM should be accurate, easy to perform, and may consider objective variables. PMs in ERCP estimate correct indication, probability of success, and the risk of developing adverse events. These models incorporate patient-related factors and technical aspects of the procedure. In the field of EUS, these models utilize clinical and imaging data to predict the likelihood of malignancy, presence of specific lesions, or risk of complications related to therapeutic interventions. Further research, validation, and refinement are necessary to maximize the utility and impact of these models in routine clinical practice.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Endosonography
PubMed: 38103924
DOI: 10.1016/j.bpg.2023.101856 -
Acta Gastro-enterologica Belgica 2023Biliary papillomatosis (BP) is a rare disorder of the biliary tract characterized by the presence of multiple papillary adenomas spread along the biliary tree. Although...
Biliary papillomatosis (BP) is a rare disorder of the biliary tract characterized by the presence of multiple papillary adenomas spread along the biliary tree. Although benign, it carries a significant risk of malignant transformation. Due to low sensitivity and specificity of conventional radiologic modalities, the diagnosis as well as estimation of disease extent is difficult. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreaticography (ERCP) are superior although direct peroral cholangioscopy (POC) is currently the most accurate diagnostic method. Mainly because it provides more detailed information and makes targeted histological diagnosis possible. The treatment of biliary papillomatosis consists of surgical resection, liver transplantation (LT) or a combination of both. Unfortunately, the recurrence rate after radical surgery without LT remains high due to the diffuse distribution of the disease.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Bile Duct Neoplasms; Sensitivity and Specificity; Adenoma; Papilloma
PubMed: 37814564
DOI: 10.51821/86.3.11733 -
Revista Espanola de Enfermedades... Jul 2023This year, 2023, marks the fiftieth anniversary of the introduction of therapeutic endoscopic retrograde cholangiopancreatography (ERCP), which completely changed the...
This year, 2023, marks the fiftieth anniversary of the introduction of therapeutic endoscopic retrograde cholangiopancreatography (ERCP), which completely changed the management of biliary and pancreatic diseases. As in other invasive procedures, two intrinsically related concepts soon appeared: drainage success and complications. It was observed that ERCP is the most dangerous procedure regularly performed by gastrointestinal endoscopists, with a morbidity and mortality of 5-10 % and 0.1-1 %, respectively. ERCP is by far one of the best examples of a complex endoscopic technique.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Pancreatic Diseases; Drainage; Retrospective Studies
PubMed: 36809925
DOI: 10.17235/reed.2023.9507/2022 -
Gastroenterology Nov 2023Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing metal stent (EUS-CDS) is a promising modality for management of malignant distal biliary... (Comparative Study)
Comparative Study Randomized Controlled Trial
Endoscopic Ultrasound-Guided Biliary Drainage of First Intent With a Lumen-Apposing Metal Stent vs Endoscopic Retrograde Cholangiopancreatography in Malignant Distal Biliary Obstruction: A Multicenter Randomized Controlled Study (ELEMENT Trial).
BACKGROUND & AIMS
Endoscopic ultrasound-guided choledochoduodenostomy with a lumen-apposing metal stent (EUS-CDS) is a promising modality for management of malignant distal biliary obstruction (MDBO) with potential for better stent patency. We compared its outcomes with endoscopic retrograde cholangiopancreatography with metal stenting (ERCP-M).
METHODS
In this multicenter randomized controlled trial, we recruited patients with MDBO secondary to borderline resectable, locally advanced, or unresectable peri-ampullary cancers across 10 Canadian institutions and 1 French institution. This was a superiority trial with a noninferiority assessment of technical success. Patients were randomized to EUS-CDS or ERCP-M. The primary end point was the rate of stent dysfunction at 1 year, considering competing risks of death, clinical failure, and surgical resection. Analyses were performed according to intention-to-treat principles.
RESULTS
From February 2019 to February 2022, 144 patients were recruited; 73 were randomized to EUS-CDS and 71 were randomized to ERCP-M. The mean (SD) procedure time was 14.0 (11.4) minutes for EUS-CDS and 23.1 (15.6) minutes for ERCP-M (P < .01); 40% of the former was performed without fluoroscopy. Technical success was achieved in 90.4% (95% CI, 81.5% to 95.3%) of EUS-CDS and 83.1% (95% CI, 72.7% to 90.1%) of ERCP-M with a risk difference of 7.3% (95% CI, -4.0% to 18.8%) indicating noninferiority. Stent dysfunction occurred in 9.6% vs 9.9% of EUS-CDS and ERCP-M cases, respectively (P = .96). No differences in adverse events, pancreaticoduodenectomy and oncologic outcomes, or quality of life were noted.
CONCLUSIONS
Although not superior in stent function, EUS-CDS is an efficient and safe alternative to ERCP-M in patients with MDBO. These findings provide evidence for greater adoption of EUS-CDS in clinical practice as a complementary and exchangeable first-line modality to ERCP in patients with MDBO.
CLINICALTRIALS
gov, Number: NCT03870386.
Topics: Humans; Male; Female; Cholangiopancreatography, Endoscopic Retrograde; Aged; Cholestasis; Middle Aged; Drainage; Stents; Endosonography; Treatment Outcome; Ultrasonography, Interventional; Choledochostomy; Metals; Aged, 80 and over
PubMed: 37549753
DOI: 10.1053/j.gastro.2023.07.024 -
Endoscopy Dec 2024
Topics: Humans; Ascariasis; Biliary Tract Diseases; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 38388953
DOI: 10.1055/a-2258-8436 -
Internal Medicine (Tokyo, Japan) Jan 2024
Topics: Humans; Gallbladder; Cholecystectomy; Cholangiopancreatography, Endoscopic Retrograde; Abdomen; Drainage
PubMed: 37164663
DOI: 10.2169/internalmedicine.1872-23 -
Jornal de Pediatria Mar 2024Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with... (Review)
Review
OBJECTIVE
Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients.
DATA SOURCES
A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023.
SUMMARY OF FINDINGS
Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed.
CONCLUSION
The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.
PubMed: 38522478
DOI: 10.1016/j.jped.2024.02.001 -
The Libyan Journal of Medicine Dec 2023Disc degeneration (DD) is a common cause of low back pain, which represents one of the most widespread public health problems in the world. Therefore, the establishment...
PURPOSE
Disc degeneration (DD) is a common cause of low back pain, which represents one of the most widespread public health problems in the world. Therefore, the establishment of a reproducible animal model is indispensable to understand the pathogenic mechanisms of DD and to test new therapeutic strategies. From this perspective, the fundamental objective of this study was to elucidate the effect of ovariectomy in establishing a new animal model of DD in rats.
METHODS
36 female Sprague-Dawley rats were divided into four groups of 9 rats: Group 1: Negative control (Sham): Only an abdominal skin incision and sutures were performed. Group 2: Ovariectomy (OVX): Removal of two ovaries through a transverse incision in the middle of the abdomen. Group 3: Puncture (Punct): Puncture of lumbar intervertebral discs (L3/4, L4/5, and L5/6) by a 21 G needle. Group 4: Puncture+ovariectomy (Punct+OVX): Removal of two ovaries and puncture of L3/4, L4/5, and L5/6 discs. The rats were euthanized 1, 3, and 6 weeks post-surgery, and the discs were harvested. Validity was assessed by radiography, histology, and biochemistry (water content).
RESULTS
Disc height, water content, and histologic score decreased significantly in the last 3 groups and at all three-time points ( < 0.05). DD progressed over time in the Punct and Punct+OVX groups ( < 0.05). The changes were more severe in the Punct+OVX group compared to the Punct group and the OVX group.
CONCLUSION
The combination of puncture and ovariectomy induced rapid and progressive DD in the lumbar discs of rats without spontaneous recovery.
Topics: Humans; Rats; Female; Animals; Intervertebral Disc Degeneration; Rats, Sprague-Dawley; Disease Models, Animal; Intervertebral Disc; Ovariectomy
PubMed: 37192334
DOI: 10.1080/19932820.2023.2212481 -
Canadian Association of Radiologists... May 2024Artificial intelligence (AI) is a rapidly growing field with significant implications for radiology. Acute abdominal pain is a common clinical presentation that can... (Review)
Review
Artificial intelligence (AI) is a rapidly growing field with significant implications for radiology. Acute abdominal pain is a common clinical presentation that can range from benign conditions to life-threatening emergencies. The critical nature of these situations renders emergent abdominal imaging an ideal candidate for AI applications. CT, radiographs, and ultrasound are the most common modalities for imaging evaluation of these patients. For each modality, numerous studies have assessed the performance of AI models for detecting common pathologies, such as appendicitis, bowel obstruction, and cholecystitis. The capabilities of these models range from simple classification to detailed severity assessment. This narrative review explores the evolution, trends, and challenges in AI applications for evaluating acute abdominal pathologies. We review implementations of AI for non-traumatic and traumatic abdominal pathologies, with discussion of potential clinical impact, challenges, and future directions for the technology.
PubMed: 38715249
DOI: 10.1177/08465371241250197 -
Clinical approach to indeterminate biliary strictures: Clinical presentation, diagnosis, and workup.World Journal of Gastroenterology Sep 2023Despite advances in cross-sectional imaging and endoscopic technology, bile duct strictures remain a challenging clinical entity. It is crucial to make an early... (Review)
Review
Despite advances in cross-sectional imaging and endoscopic technology, bile duct strictures remain a challenging clinical entity. It is crucial to make an early determination of benign or malignant nature of biliary strictures. Early diagnosis not only helps with further management but also minimizes mortality and morbidity associated with delayed diagnosis. Conventional imaging and endoscopic techniques, particularly endoscopic retrograde cholangiopancreatography (ERCP) and tissue sampling techniques play a key in establishing a diagnosis. Indeterminate biliary strictures (IDBSs) have no definite mass on imaging or absolute histopathological diagnosis and often warrant utilization of multiple diagnostics to ascertain an etiology. In this review, we discuss possible etiologies, clinical presentation, diagnosis, and management of IDBSs. Based on available data and expert opinion, we depict an evidence based diagnostic algorithm for management of IDBSs. Areas of focus include use of traditional tissue sampling techniques such as ERCP with brush cytology, intraductal biopsies, fluorescence hybridization and flow cytometry. We also describe the role of endoscopic ultrasound (EUS)-guided fine needle aspiration and biopsies, cholangioscopy, confocal laser endomicroscopy, and intraductal EUS in management of IDBSs.
Topics: Humans; Constriction, Pathologic; In Situ Hybridization, Fluorescence; Cholestasis; Cholangiopancreatography, Endoscopic Retrograde; Biopsy
PubMed: 37901449
DOI: 10.3748/wjg.v29.i36.5198