-
Neurogastroenterology and Motility Sep 2020The EndoFLIP system is a method of delineating impedance and was first designed to investigate the characteristics of the esophago-gastric junction. In the last decade,... (Review)
Review
The EndoFLIP system is a method of delineating impedance and was first designed to investigate the characteristics of the esophago-gastric junction. In the last decade, its use was widened to investigate other sphincteric and non-sphincteric systems of the gastrointestinal tract. The objective of the present systematic review was to summarize the available data in literature on the use of the EndoFLIP system in the gastrointestinal tract, including sphincteric and non-sphincteric regions. We performed a systematic review in accordance with recommendations for systematic review using PRISMA guidelines without date restriction, until June 2020, using MEDLINE-PubMed, Cochrane Library, and Google Scholar databases. Only articles written in English were included in the present review. Five hundred and six unique citations were identified from all database combined. Of those, 95 met the inclusion criteria. There was a lack of standardization among studies in terms of anesthetic drugs use, probe placement, and inflation protocol. In most cases, only small cohorts of patients were included. Most studies investigated the EGJ, with a potential use of the EndoFLIP to identify a subgroup of patients with achalasia and for intraoperative assessment of treatment efficacy in achalasia. However, the use of EndoFLIP in the esophageal body (esophageal panometry), other esophageal diseases (gastro-esophageal reflux disease, eosinophilic esophagitis), and other sphincter regions (anal canal, pylorus) will need further confirmatory studies. The EndoFLIP system provides detailed geometric data of the gastrointestinal lumen but further works are needed to determine its use in clinical practice.
Topics: Electric Impedance; Esophageal Diseases; Gastrointestinal Tract; Humans; Manometry
PubMed: 32856765
DOI: 10.1111/nmo.13980 -
Neurogastroenterology and Motility Apr 2021Esophageal acid exposure time (AET) during 24 h pH monitoring is reproducible and predictive outcomes of treatment for gastroesophageal reflux disease. Several small... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Esophageal acid exposure time (AET) during 24 h pH monitoring is reproducible and predictive outcomes of treatment for gastroesophageal reflux disease. Several small Asian studies have investigated the normal range of the AET; the range may be different from that in Western populations. We evaluated its normal range in healthy Asian compared to Western subjects.
METHODS
We searched PubMed, Embase, Cochrane Library, and KoreaMed for studies that reported pH monitoring parameters in healthy subjects. Studies that reported the AET values of healthy subjects were eligible for the analyses. The upper limit of normal of the AET was obtained from the 95th percentile of the available raw data or calculated as the mean value +2 standard deviations.
KEY RESULTS
Nineteen Asian and 49 Western studies were assessed. The estimated AET values were analyzed using a bootstrapping technique, weighted according to the sample size. The mean AET was 1.1% and 2.9% in the Asian and Western populations, respectively. The upper limit of the reference range was 3.2% (95% confidence interval [CI], 2.7-3.9%) and 8.2 (95% CI, 6.7-9.9) in the Asian and Western populations, respectively. The normal AET differed between the Asian and Western populations because the CI of the two groups did not overlap.
CONCLUSIONS & INFERENCES
The upper limit of normal of the AET in healthy Asian subjects was 3.2% (95% CI, 2.7-3.9%), which was lower than that of healthy Western subjects.
Topics: Asia; Electric Impedance; Esophageal pH Monitoring; Gastric Acid; Gastric Acidity Determination; Gastroesophageal Reflux; Germany; Healthy Volunteers; Humans; Manometry; Population Surveillance; Reference Values; Turkey; United States
PubMed: 33377596
DOI: 10.1111/nmo.14029 -
Dysphagia Dec 2022Glottal incompetence caused by unilateral vocal fold paralysis (UVFP) is a common cause of dysphagia and aspiration. Treatments targeted at reducing glottal incompetence...
Glottal incompetence caused by unilateral vocal fold paralysis (UVFP) is a common cause of dysphagia and aspiration. Treatments targeted at reducing glottal incompetence by injection augmentation or medialization thyroplasty are well established at improving voice outcomes, but improvements in swallowing function are less clear. The objective of this systematic review was to determine the impact of vocal fold medialization on dysphagia outcomes. Six electronic bibliographic databases and one clinical trial registry were searched on 3/13/2020. Our patient population were adult patients with verified UVFP that underwent vocal fold medialization. We limited review to prospective studies that had formal dysphagia assessment both before and after medialization. Nine studies met selection criteria (7 prospective case series and 2 prospective cohort studies) totaling 157 patients. The most common etiology of UVFP was iatrogenic (74/157; 47%). The majority of patients underwent injection augmentation (92/157; 59%), and the remaining underwent medialization thyroplasty. A variety of methods were used to assess changes in dysphagia including patient-reported outcome measures, flexible endoscopic evaluation of swallowing, videofluoroscopic swallow study, and high-resolution manometry. 7/9 studies demonstrated clinically significant improvement in swallowing function following medialization; 4/9 studies demonstrated statistically significant improvement, and three studies did not show statistically significant improvement after intervention. Study participants and outcome measures evaluating swallowing function in this review were heterogeneous. Moreover, the reviewed studies are concerning for multiple risks of bias impacting their conclusions. Taken together, this systematic review demonstrates limited evidence that injection augmentation and medialization thyroplasty improve swallowing function and/or safety.
Topics: Adult; Humans; Deglutition; Vocal Cords; Prospective Studies; Deglutition Disorders; Vocal Cord Paralysis; Treatment Outcome
PubMed: 35412149
DOI: 10.1007/s00455-022-10441-5 -
Journal of Sleep Research Dec 2022This study aimed to evaluate the diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea as an alternative to... (Meta-Analysis)
Meta-Analysis
This study aimed to evaluate the diagnostic accuracy of home sleep apnea testing using peripheral arterial tonometry for sleep apnea as an alternative to polysomnography. We conducted a systematic review and meta-analysis of observational studies, randomized controlled trials, and diagnostic case-control studies examining the diagnostic accuracy of peripheral arterial tonometry by searching the CENTRAL, MEDLINE, EMBASE, ICTRP and ClinicalTrials.gov databases on 5 October 2021. We assessed the risk of bias of the included studies using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random-effects model was generated to derive the summary point estimates of sensitivity and specificity with 95% confidence intervals at different apnea-hypopnea index cutoffs. This meta-analysis included 13 studies (1227 participants, median prevalence of sleep apnea with apnea-hypopnea index ≥ 5 events per hr: 85%). The risk of bias in the included studies was low to moderate. The pooled sensitivity and specificity estimates were 96% (95% confidence interval: 93%-97%) and 44% (95% confidence interval: 32%-56%) at apnea-hypopnea index ≥ 5 events per hr, 88% (85%-91%) and 74% (63%-83%) at apnea-hypopnea index ≧ 15 events per hr, and 80% (66%-89%) and 90% (83%-95%) at apnea-hypopnea index ≧ 30 events per hr, respectively. Peripheral arterial tonometry resulted in a significant number of false negatives and false positives at any apnea-hypopnea index cutoff when applied to the median prevalence setting of the included studies. The inadequate sensitivity and specificity of peripheral arterial tonometry render it an unsuitable alternative to polysomnography for detecting sleep apnea for apnea-hypopnea index ≧ 5, 15 and 30 events per hr.
Topics: Humans; Sleep Apnea, Obstructive; Polysomnography; Sleep Apnea Syndromes; Sleep; Manometry
PubMed: 35793907
DOI: 10.1111/jsr.13682 -
The British Journal of Surgery May 2020Antireflux surgery is commonly performed in children, yet evidence for its efficacy is limited. The aim of this review was to determine the effect of antireflux surgery...
BACKGROUND
Antireflux surgery is commonly performed in children, yet evidence for its efficacy is limited. The aim of this review was to determine the effect of antireflux surgery with regard to objective measures of quality of life (QoL) and value of upper gastrointestinal investigations in neurologically normal (NN) and neurologically impaired (NI) children.
METHODS
A systematic review was conducted of articles reporting children undergoing antireflux surgery in whom preoperative and postoperative objective testing was performed. Primarily, Embase, CINAHL, MEDLINE and PubMed were searched from inception to April 2019. Methodological Index for Non-randomized Studies (MINORS) criteria were used to assess article quality.
RESULTS
Of 789 articles, 14 met the eligibility criteria, 12 prospective observational and 2 retrospective studies. The median MINORS score was 59·4 (i.q.r. 39 to 62·5) per cent. Seven studies reported assessment of validated QoL measures before and after antireflux surgery in 148 children. Follow-up ranged from 1 to 180 months. All studies confirmed significant improvements in QoL measures among NN and NI children at all follow-up points. Eleven studies reported on preoperative and postoperative investigations in between 416 and 440 children children. Follow-up ranged from 0·5 to 180 months. Nine studies confirmed improvements in gastro-oesophageal reflux using 24-h oesophageal pH monitoring with or without manometry, but conflicting results were identified for four studies reporting gastric emptying. No studies reported fluoroscopy or endoscopy adequately.
CONCLUSION
Based on the results of studies of low-to-moderate quality, antireflux surgery improved QoL and reduced oesophageal acid exposure in NN and NI children in the short and medium term. Although antireflux surgery is a common elective operation, the lack of rigorous preoperative and postoperative evaluation(s) in the majority of patient-reported studies is striking.
Topics: Case-Control Studies; Child; Fundoplication; Gastroesophageal Reflux; Humans; Nervous System Diseases; Quality of Life; Treatment Outcome
PubMed: 32083325
DOI: 10.1002/bjs.11488 -
Sleep & Breathing = Schlaf & Atmung Jun 2023Home sleep apnea testing devices aim to overcome the drawbacks of polysomnography (PSG). Among these, the WatchPAT (WP) (Itamar Medical Ltd., Caesarea, Israel) has... (Review)
Review
PURPOSE
Home sleep apnea testing devices aim to overcome the drawbacks of polysomnography (PSG). Among these, the WatchPAT (WP) (Itamar Medical Ltd., Caesarea, Israel) has recently been introduced on the market for diagnosis of Obstructive Sleep Apnea (OSA). The aim of this review was to provide a comprehensive overview of the studies validating the WP for the diagnosis of sleep-disordered breathing through comparison with PSG.
METHODS
A systematic review was performed to identify all clinical studies concerning WP validation compared with PSG as diagnostic tools. A qualitative analysis of the data was conducted.
RESULTS
In this review, 18 studies were included for a total of 1049 patients, aged 8 to 70 years old, with 74 of these being pediatric patients. In most studies, patients completed an overnight PSG and simultaneously wore WatchPAT in a sleep laboratory, while others compared the results obtained on two different nights. Both protocols showed good results in terms of AHI, ODI, RDI, and SO2. Moreover, some studies calculated the sensitivity and specificity of the WP ranging from 87 to 96% and from 66 to 80%, respectively. Excellent results were found also in pediatric patients.
CONCLUSION
The WP represents an effective and convenient tool for OSA diagnosis compared to standard reference systems.
Topics: Humans; Child; Adolescent; Young Adult; Adult; Middle Aged; Aged; Wrist; Sleep Apnea, Obstructive; Sleep; Sleep Apnea Syndromes; Manometry
PubMed: 36036338
DOI: 10.1007/s11325-022-02700-4 -
Journal of Clinical GastroenterologyWith the advent of high-resolution esophageal manometry, it is recognized that the antireflux barrier receives a contribution from both the lower esophageal sphincter...
With the advent of high-resolution esophageal manometry, it is recognized that the antireflux barrier receives a contribution from both the lower esophageal sphincter (intrinsic sphincter) and the muscle of the crural diaphragm (extrinsic sphincter). Further, an increased intra-abdominal pressure is a major force responsible for an adaptive response of a competent sphincter or the disruption of the esophagogastric junction resulting in gastroesophageal reflux, especially in the presence of a hiatal hernia. This review describes how the pressure dynamics in the lower esophageal sphincter were discovered and measured over time and how this has influenced the development of antireflux surgery.
Topics: Esophageal Sphincter, Lower; Esophagogastric Junction; Gastroesophageal Reflux; Hernia, Hiatal; Humans; Manometry; Pressure
PubMed: 36084164
DOI: 10.1097/MCG.0000000000001756 -
Journal of Smooth Muscle Research =... 2023Esophageal achalasia is classified into three subtypes according to manometric findings. Since several factors, including clinical characteristics and treatment...
Esophageal achalasia is classified into three subtypes according to manometric findings. Since several factors, including clinical characteristics and treatment response, have been reported to differ among the subtypes, the underlying pathogenesis may also differ. However, a comprehensive understanding regarding the differences is still lacking. We therefore performed a systematic review of the differences among the three subtypes of achalasia to clarify the current level of comprehension. In terms of clinical features, type III, which is the least frequently diagnosed of the three subtypes, showed the oldest age and most severe symptoms, such as chest pain. In contrast, type I showed a higher prevalence of lung complications, and type II showed weight loss more frequently than the other types. Histopathologically, type I showed a high loss of ganglion cells in esophagus, and on a molecular basis, type III had elevated serum pro-inflammatory cytokine levels. In addition to peristalsis and the lower esophageal sphincter (LES) function, the upper esophageal sphincter (UES) function of achalasia has attracted attention, as an impaired UES function is associated with severe aspiration pneumonia, a fatal complication of achalasia. Previous studies have indicated that type II shows a higher UES pressure than the other subtypes, while an earlier decline in the UES function has been confirmed in type I. Differences in the treatment response are also crucial for managing achalasia patients. A number of studies have reported better responses in type II cases and less favorable responses in type III cases to pneumatic dilatation. These differences help shed light on the pathogenesis of achalasia and support its clinical management according to the subtype.
Topics: Humans; Esophageal Achalasia; Manometry; Esophageal Sphincter, Lower; Esophageal Sphincter, Upper; Chest Pain
PubMed: 36948611
DOI: 10.1540/jsmr.59.14 -
BMC Anesthesiology Feb 2024To evaluate and summarize literature pertaining to evidence of peripheral arterial catheterization in adults, and to provide a reference for clinical practice.
OBJECTIVE
To evaluate and summarize literature pertaining to evidence of peripheral arterial catheterization in adults, and to provide a reference for clinical practice.
METHODS
We undertook a systematic review of literature on the removal of peripheral arterial manometric catheters in adult patients from various sources such as UpToDate, BMJ, National Institute for Health and Care Excellence (NICE), Medlive, Cochrane Library, Joanna Briggs Institute (JBI) Evidence-based Health Care Center Database, CINAHL, PubMed, Wanfang Data, VIP, and other databases. The retrieval time was set as from the establishment of the database till August 30, 2021. We screened the studies that fulfilled the inclusion criteria, evaluated their quality, and retrieved and summarized such articles.
RESULTS
The review included 8 articles: 1 clinical decision, 3 guidelines, 2 evidence summaries, 1 systematic review, and 1 expert consensus. In all, 17 pieces of strong evidence were collected and extracted based on the following 5 dimensions: assessment of removal timing, preparation before removal, removal procedure, compression time, and key points after removal.
CONCLUSIONS
The removal of a peripheral arterial manometry catheter requires careful consideration by medical professionals. In order to increase the removal standardization rate and decrease the incidence of clinical complications, standardized procedures and training need to be developed.
Topics: Adult; Humans; Critical Illness; Catheters, Indwelling; Cannula; Arteries; Catheterization, Peripheral
PubMed: 38408893
DOI: 10.1186/s12871-024-02458-0 -
International Urogynecology Journal Aug 2020The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION AND HYPOTHESIS
The literature presents controversial results regarding the role of delivery mode in pelvic floor muscle (PFM) function after birth. Some studies showed a greater impairment of PFM function after vaginal delivery compared with cesarean section, while others have not identified a significant difference between these two modes of delivery. This study aimed to investigate whether there was a difference in short-term PFM function after childbirth in primiparous women who underwent cesarean section compared with those who underwent vaginal delivery.
METHODS
Up to December 2018, the PubMed-MEDLINE, CINAHL, Embase, Bireme, Scopus, Web of Science, and Science Direct databases were searched. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. Observational studies comparing PFM function after cesarean section versus vaginal delivery in primiparous women were included. PRISMA guidelines and Cochrane recommendations were followed. Methodological quality of the primary studies was assessed through the checklist proposed by the Joanna Briggs Institute for cross-sectional studies. Random effects meta-analysis was performed to synthesize evidence regarding PFM strength in primiparous woman after vaginal delivery compared with cesarean section. The GRADE approach was applied to classify the quality of the evidence.
RESULTS
Eleven studies met the inclusion criteria and were included in this review. A total of 1726 primiparous women were analyzed after childbirth. Five studies were included in the meta-analysis. No difference in PFM strength after childbirth was identified when cesarean section was compared with vaginal delivery [standardized mean difference (SMD): -0.15, 95% confidence interval (CI): -0.85 to 0.56]. Differences in PFM strength were identified when patients who underwent cesarean section were compared with those with an episiotomy or instrumented vaginal delivery (SMD: -12.51, CI 95%: -24.57 to -0.44), favoring the cesarean section group. In both cases, the quality of evidence was classified as very low because of the observational design of the included studies and population heterogeneity.
CONCLUSION
There was no difference in short-term PFM strength after childbirth between primiparous women who underwent cesarean section or vaginal delivery, as assessed through vaginal manometry. However, we identified reduced PFM strength in women who underwent an episiotomy or instrumented vaginal delivery compared with those who underwent cesarean section. Nevertheless, this conclusion should be cautiously considered as the observational design of the primary studies and possible heterogeneity among the primiparous women included in the studies contributed to reducing the quality of the evidence synthesized. Future primary studies with longitudinal designs and long-term follow-up periods are needed to strengthen the quality of evidence and provide more conclusive evidence to guide clinical practice.
Topics: Cesarean Section; Cross-Sectional Studies; Delivery, Obstetric; Female; Humans; Muscle Strength; Parturition; Pelvic Floor; Postpartum Period; Pregnancy
PubMed: 32062680
DOI: 10.1007/s00192-020-04231-6