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The Turkish Journal of Gastroenterology... Mar 2016The current systematic review and meta-analysis study assessed the prevalence of celiac disease (CD) in Iran. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIMS
The current systematic review and meta-analysis study assessed the prevalence of celiac disease (CD) in Iran.
MATERIALS AND METHODS
Electronic databases, including MEDLINE, SCOPUS, Web of Science, Cochrane library Collaboration, and Iranian scientific databases, were searched from 1993 to 2013 for English and Persian articles. The following terms were used, alone or combined, "celiac (MeSH)," "ceoliac," "prevalence (MeSH)," and "Iran*." Heterogeneity was assessed using the I2 statistic with a cut-off value of 50%, and the Chi-square test was used to define a statically significant degree of heterogeneity with a p value of <0.10. The publication bias of literatures was assessed by visual examination of the funnel plot and Begger's funnel plot.
RESULTS
Meta-analysis was conducted on seven publications with 9,720 subjects. Overall, the pooled prevalence of CD among the Iranian population was 0.72% [95% confidence interval (CI): 0.62%-0.98%]. There was no significant heterogeneity among the studies (I2=4%, p=0.396). The pooled prevalence of CD on the basis of IgA-anti tissue transglutaminase (tTGA) and tTGA and duodenal biopsy positivity was 0.83% (95% CI: 0.69%-1.14%) and 0.79% (95% CI: 0.66%-1.09%), respectively. No significant publication bias was observed using the funnel plot and Begger's funnel plot.
CONCLUSION
CD prevalence among the Iranian population was approximately similar to that of the American and European populations.
Topics: Biopsy; Celiac Disease; Duodenum; Female; Humans; Immunoglobulin A; Iran; Male; Observational Studies as Topic; Prevalence; Transglutaminases
PubMed: 27015617
DOI: 10.5152/tjg.2015.150191 -
Pediatric Surgery International Nov 2022To assess the safety and efficacy of laparoscopic versus open repair of congenital duodenal obstruction (CDO), we conducted a systematic review and meta-analysis (CDO). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess the safety and efficacy of laparoscopic versus open repair of congenital duodenal obstruction (CDO), we conducted a systematic review and meta-analysis (CDO).
METHODS
A literature search was conducted to identify studies that compared laparoscopic surgery (LS) and open surgery (OS) for neonates with CDO. Meta-analysis was used to pool and compare variables such as operative time, time to feeding, length of hospital stay, anastomotic leak or stricture, postoperative ileus, wound infection, and overall postoperative complications.
RESULTS
Among the 1348 neonatal participants with CDO in the ten studies, 304 received LS and 1044 received OS. When compared to the OS approach, the LS approach resulted in shorter hospital stays, faster time to initial and full feeding, longer operative time, and less wound infection. However, no significant difference in secondary outcomes such as anastomotic leak or stricture, postoperative ileus, and overall postoperative complications was found between LS and OS.
CONCLUSIONS
LS is a safe, feasible and effective surgical procedure for neonatal CDO when compared to OS. Compared with OS, LS has a faster time to feeding, a shorter hospital stay, and less wound infection. Furthermore, in terms of anastomotic leak or stricture, postoperative ileus, and overall postoperative complications, LS is equivalent to OS. We conclude that LS should be considered an acceptable option for CDO.
Topics: Anastomotic Leak; Constriction, Pathologic; Duodenal Obstruction; Humans; Ileus; Infant, Newborn; Laparoscopy; Length of Stay; Postoperative Complications; Retrospective Studies; Treatment Outcome; Wound Infection
PubMed: 36053328
DOI: 10.1007/s00383-022-05209-9 -
Arab Journal of Gastroenterology : the... Sep 2020Peptic ulcer disease (PUD) is one of the most common gastrointestinal disorders worldwide. Recent epidemiologic studies have suggested the protective effect of statins... (Meta-Analysis)
Meta-Analysis
BACKGROUND/OBJECTIVES
Peptic ulcer disease (PUD) is one of the most common gastrointestinal disorders worldwide. Recent epidemiologic studies have suggested the protective effect of statins against the development of PUD although the results were inconsistent. This systematic review and meta-analysis was conducted with the aim to summarise all available data.
METHODS
A literature review was performed using MEDLINE and EMBASE database from inception to December 2017. Cohort, case-control and cross-sectional studies that compared the risk of PUD among statins users versus non-users were included. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method.
RESULTS
A total of 3 studies (1 case-control and 2 retrospective cohort studies) met the eligibility criteria and were included in this meta-analysis. The risk of PUD was numerically lower among statins-users compared with non-users with the pooled OR of 0.89. However, the result did not achieve statistical significance with 95% CI of 0.67-1.18. The between-study statistical heterogeneity was high (I = 80%).
CONCLUSIONS
This systematic review and meta-analysis found that the risk of PUD was numerically lower among statin users. However, the results did not reach statistical significance. More studies are still required to further characterise this potential protective effect.
Topics: Cross-Sectional Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Odds Ratio; Peptic Ulcer; Retrospective Studies
PubMed: 32830090
DOI: 10.1016/j.ajg.2020.07.007 -
Diseases of the Colon and Rectum Nov 2007This study was designed to review safety and efficacy of strictureplasty for Crohn's disease. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This study was designed to review safety and efficacy of strictureplasty for Crohn's disease.
METHODS
A literature search was performed to identify studies published between 1975 and 2005 that reported the outcome of strictureplasty. Systematic review was performed on the following subjects separately: 1) overall experience of strictureplasty; 2) postoperative complications; 3) postoperative recurrence and site of recurrence; 4) factors affecting postoperative complications and recurrence; 5) short-bowel syndrome; and 6) cancer risk. Meta-analysis of recurrence rate after strictureplasty was performed by using random-effect model and meta-regressive techniques.
RESULTS
A total of 1,112 patients who underwent 3,259 strictureplasties (Heineke-Mikulicz, 81 percent; Finney, 10 percent; side-to-side isoperistaltic, 5 percent) were identified. The sites of strictureplasty were jejunum and/or ileum (94 percent), previous anastomosis (4 percent), duodenum (1 percent), and colon (1 percent). After jejunoileal strictureplasty, including ileocolonic strictureplasty, septic complications (leak/fistula/abscess) occurred in 4 percent of patients. Overall surgical recurrence was 23 percent (95 percent confidence interval, 17-30 percent). Using meta-regressive analysis, the five-year recurrence rate after strictureplasty was 28 percent. In 90 percent of patients, recurrence occurred at nonstrictureplasty sites, and the site-specific recurrence rate was 3 percent. Two patients developed adenocarcinoma at the site of previous jejunoileal strictureplasty. The experience of duodenal or colonic strictureplasty was limited.
CONCLUSIONS
Strictureplasty is a safe and effective procedure for jejunoileal Crohn's disease, including ileocolonic recurrence, and it has the advantage of protecting against further small bowel loss. However, the place for strictureplasty is less well defined in duodenal and colonic diseases.
Topics: Adenocarcinoma; Anastomosis, Surgical; Colonic Neoplasms; Crohn Disease; Digestive System Surgical Procedures; Humans; Ileum; Jejunum; Recurrence; Short Bowel Syndrome; Treatment Outcome
PubMed: 17762967
DOI: 10.1007/s10350-007-0279-5 -
The Surgeon : Journal of the Royal... Apr 2023A large proportion of patients diagnosed with inflammatory bowel disease are obese. Outcomes of bariatric surgery in patients with IBD and on IBD disease course itself... (Review)
Review
A large proportion of patients diagnosed with inflammatory bowel disease are obese. Outcomes of bariatric surgery in patients with IBD and on IBD disease course itself is not clear. Furthermore, there is some evidence that bariatric surgery can precipitate the development of de-novo IBD. Thus, the aim of this systematic review was to summarise the evidence from the literature surrounding these questions. A comprehensive literature review was conducted based on the preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA). PUBMED, and MEDLINE databases was searched using a combination of keywords and MeSH terms including "gastric bypass", "sleeve gastrectomy", "Roux-en-Y", "Duodenal switch", "RYGB", "bariatric surgery" and "inflammatory bowel disease", "Crohn's disease" ,"Ulcerative colitis". Studies published up to March 2020 were included in this analysis. 22 studies met the inclusion criteria. Studies revealed that bariatric surgery is safe and effective for patients with IBD and resulted in significant weight loss at both the 6-month and 12-month time points. Furthermore, multiple studies reported de-novo IBD development following bariatric surgery in a selection of patients.
Topics: Humans; Obesity, Morbid; Inflammatory Bowel Diseases; Bariatric Surgery; Obesity; Gastric Bypass; Gastrectomy; Retrospective Studies
PubMed: 35660070
DOI: 10.1016/j.surge.2022.04.008 -
The Surgeon : Journal of the Royal... Dec 2017The incidence of duodenal perforation after ERCP ranges from 0.09% to 1.67% and mortality up to 8%. (Review)
Review
INTRODUCTION
The incidence of duodenal perforation after ERCP ranges from 0.09% to 1.67% and mortality up to 8%.
METHODS
This systematic review was registered in Prospective Register of Systematic Reviews, PROSPERO. Stapfer classification of ERCP-related duodenal perforations was used.
RESULTS
The systematic search yielded 259 articles. Most frequent post-ERCP perforation was Stapfer type II (58.4%), type I second most frequent perforation (17.8%) followed by Stapfer type III in 13.2% and type IV in 10.6%. Rate of NOM was lowest in Stapfer type I perforations (13%), moderate in type III lesions (58.1%) and high in other types of perforations (84.2% in type II and 84.6% in IV). In patients underwent early surgical treatment (<24 h from ERCP) the most frequent operation was simple duodenal suture with or without omentopexy (93.7%). In patients undergoing late surgical treatment (>24 h from ERCP) interventions performed were more complex. In type I lesions post-operative mortality rate was higher in patients underwent late operation (>24 h). In type I lesions, failure of NOM occurred in 42.8% of patients. In type II failure of NOM occurred in 28.9% of patients and in type III there was failure of NOM in only 11.1%, none in type IV. Postoperative mortality after NOM failure was 75% in type I, 22.5% in type II and none died after surgical treatment for failure of NOM in type III perforations.
CONCLUSIONS
This systematic review showed that in patients with Stapfer type I lesions, early surgical treatment gives better results, however the opposite seems true in Stapfer III and IV lesions.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Duodenal Diseases; Duodenum; Humans; Intestinal Perforation
PubMed: 28619547
DOI: 10.1016/j.surge.2017.05.004 -
Helicobacter Apr 2012The most common complications of peptic ulcer are bleeding and perforation. In many regions, definitive acid reduction surgery has given way to simple closure and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The most common complications of peptic ulcer are bleeding and perforation. In many regions, definitive acid reduction surgery has given way to simple closure and Helicobacter pylori eradication.
AIM
To perform a systematic review and meta-analysis to ask whether this change in practice is in fact justified.
MATERIALS AND METHODS
A search on the Cochrane Controlled Trials Register, Medline, and Embase was made for controlled trials of duodenal ulcer perforation patients using simple closure method plus postoperative H. pylori eradication therapy versus simple closure plus antisecretory non-eradication therapy. The long-term results for prevention of ulcer recurrence were compared.
RESULTS
The pooled incidence of 1-year ulcer recurrence in H. pylori eradication group was 5.2% [95% confidence interval (CI) of 0.7 and 9.7], which is significantly lower than that of the control group (35.2%) with 95% CI of 0.25 and 0.45. The pooled relative risk was 0.15 with 95% CI of 0.06 and 0.37.
CONCLUSIONS
Helicobacter pylori eradication after simple closure of duodenal ulcer perforation gives better result than the operation plus antisecretory non-eradication therapy for prevention of ulcer recurrence. All duodenal ulcer perforation patients should be tested for H. pylori infection, and eradication therapy is required in all infected patients.
Topics: Anti-Bacterial Agents; Helicobacter Infections; Helicobacter pylori; Humans; Peptic Ulcer Perforation; Randomized Controlled Trials as Topic
PubMed: 22404446
DOI: 10.1111/j.1523-5378.2011.00928.x -
Annals of Surgical Oncology Oct 2014This study was designed to compare the clinical outcomes of patients who underwent limited resection (LR) versus pancreaticoduodenectomy (PD) for duodenal... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
This study was designed to compare the clinical outcomes of patients who underwent limited resection (LR) versus pancreaticoduodenectomy (PD) for duodenal gastrointestinal stromal tumors (GISTs).
METHODS
A systematic review of the literature was performed to identify studies analyzing the clinical outcomes of LR and PD for duodenal GISTs.
RESULTS
Eleven studies were included, of which 7 that compared 162 patients who underwent LR versus 98 patients who underwent PD were suitable for meta-analysis. Patients who underwent PD were more likely to have tumors which were large (≥ 5 cm) [76.0 vs. 36.6 %, odds ratio (OR) 5.49, 95 % confidence interval (CI) 1.8-16.76], with high mitotic count ≥5/50 high-power field (HPF) (33.7 vs. 18.5 %, OR 2.23, 95 % CI 1.22-4.08), classified as high risk (60.3 vs. 32.0 %, OR 3.23, 95 % CI 1.65-6.34), and which were located at D2 (80.5 vs. 28.6 %, OR 10.33, 95 % CI 5.22-20.47) compared with LR. PD was associated with a higher postoperative morbidity rate than LR [48.3 vs. 20.7 %, relative risk (RR) 2.34, 95 % CI 1.61-3.42]. LR was not associated with an increased local recurrence rate, had a better DFS [hazard ratio (HR) 2.07, 95 % CI 1.07-4.01], and lower rate of distant metastasis (8.9 vs. 25.8 %, OR 0.28, 95 % CI 0.13-0.59) compared with PD.
CONCLUSIONS
LR should be the procedure of choice for duodenal GIST whenever technically feasible, because it is associated with good oncologic outcomes and lower morbidity compared with PD. The oncologic outcome of GIST is more likely to be dependent on tumor biology rather that the type of surgical resection. The use of Imatinib in patients with duodenal GIST may potentially allow a proportion of patients who would otherwise require a PD to undergo LR instead.
Topics: Duodenal Neoplasms; Gastrointestinal Stromal Tumors; Humans; Pancreatectomy; Pancreaticoduodenectomy; Prognosis
PubMed: 24854490
DOI: 10.1245/s10434-014-3788-1 -
The American Journal of Gastroenterology Apr 2024Individuals with familial adenomatous polyposis (FAP) have an almost 20% lifetime risk of duodenal adenocarcinoma, currently the leading cause of death in FAP. The... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Individuals with familial adenomatous polyposis (FAP) have an almost 20% lifetime risk of duodenal adenocarcinoma, currently the leading cause of death in FAP. The Spigelman staging system provides guidance on the surveillance intervals and timing of prophylactic surgery. Still, its accuracy in predicting duodenal and papillary cancer development has not been systematically evaluated. We investigated the sensitivity and cancer risk of the Spigelman stages.
METHODS
We performed a systematic review on PubMed, MEDLINE, EMBASE, and Cochrane and used a random-effects model to pool effect sizes.
RESULTS
After removing duplicate entries, we screened 1,170 records and included 27 studies for quantitative analysis. Once duodenal polyposis reaches Spigelman stage IV, the risk of duodenal and papillary cancers increased to 25% (95% confidence interval [CI] 12%-45%). However, the sensitivity of Spigelman stage IV for these cancers was low (51%, 95% CI 42%-60%), especially for papillary adenocarcinoma (39%, 95% CI 16%-68%). We investigated the reasons behind these low values and observed that duodenal cancer risk factors included polyps >10 mm, polyp count >20, and polyps with high-grade dysplasia. Risk factors associated with papillary cancer included a papilla with high-grade dysplasia or >10 mm. The evidence on other risk factors was inconclusive.
DISCUSSION
The current Spigelman staging system had a low sensitivity for duodenal and papillary adenocarcinomas. Two Spigelman variables (duodenal villous histology and polyp count) and the lack of papilla-specific variables likely contributed to the low sensitivity values for duodenal and papillary cancers, respectively. While clinicians may be familiar with its current form, there is an urgent need to update it.
Topics: Humans; Adenomatous Polyposis Coli; Duodenum; Duodenal Neoplasms; Polyps; Risk Factors
PubMed: 38294150
DOI: 10.14309/ajg.0000000000002688 -
ANZ Journal of Surgery May 2023Duodenal diverticulum occurs in approximately 20% of the population and can lead to life-threatening complications such as perforation. Most perforations are secondary...
BACKGROUND
Duodenal diverticulum occurs in approximately 20% of the population and can lead to life-threatening complications such as perforation. Most perforations are secondary to diverticulitis, with iatrogenic causes being exceptionally rare. This systematic review explores the aetiology, prevention and outcomes of iatrogenic perforation of duodenal diverticulum.
METHODS
A systematic review was performed according to the PRISMA guidelines. Four databases were searched, including Pubmed, Medline, Scopus and Embase. The primary data extracted were clinical findings, type of procedure, prevention and management of perforation and outcomes.
RESULTS
Forty-six studies were identified, of which 14 articles met inclusion criteria and comprised 19 cases of iatrogenic duodenal diverticulum perforation. Four cases identified duodenal diverticulum pre-intervention, nine were identified peri-intervention, and the remainder were identified post-intervention. Perforation secondary to endoscopic retrograde cholangiopancreatography (n = 8) was most common, followed by open and laparoscopic surgery (n = 5), gastroduodenoscopy (n = 4) and other (n = 2). Operative management with diverticulectomy was the most frequent treatment (63%). Iatrogenic perforation was associated with 50% morbidity and 10% mortality.
CONCLUSION
Iatrogenic perforation of duodenal diverticulum is exceptionally rare and associated with high morbidity and mortality. There are limited guidelines surrounding standard perioperative steps to prevent iatrogenic perforations. A review of preoperative imaging helps identify potential aberrant anatomy, such as a duodenal diverticulum, to allow for recognition and prompt management initiation in the event of perforation. Intraoperative recognition and immediate surgical repair are safe options for this complication.
Topics: Humans; Duodenal Ulcer; Cholangiopancreatography, Endoscopic Retrograde; Gastroscopy; Diverticulum; Iatrogenic Disease; Intestinal Perforation
PubMed: 36881513
DOI: 10.1111/ans.18376