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Surgical Endoscopy Nov 2018The forward-viewing endoscope has been increasingly used to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients who underwent Billroth II... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The forward-viewing endoscope has been increasingly used to perform endoscopic retrograde cholangiopancreatography (ERCP) in patients who underwent Billroth II gastrectomy. This study intended to assess efficacy and safety of the forward-viewing endoscope for ERCP in Billroth II gastrectomy patients compared with conventional side-viewing endoscope using a systematic review and meta-analysis.
METHODS
A systematic review was conducted for studies that evaluated the outcomes of ERCP for patients with Billroth II gastrectomy. Random-effect model meta-analyses with subgroup analyses were conducted. The methodological quality of the included publications was evaluated using the risk of bias assessment tool for non-randomized studies. The publication bias was assessed.
RESULTS
In total, 25 studies (1 randomized, 18 retrospective, 1 prospective, and 5 case series studies) with 2446 patients (499 forward-viewing and 1947 side-viewing endoscopes) were analyzed. The pooled afferent loop intubation rate was higher with the forward-viewing endoscope (90.3%, 95% confidence interval (CI) 85.6-93.6 vs. 86.8%, 95% CI 82.8-89.9%). The pooled selective cannulation rate was higher with the side-viewing endoscope (92.3%, 95% CI 88.0-95.2 vs. 91.1%, 95% CI 87.2-93.9%). The pooled bowel perforation rate was higher with the side-viewing endoscope (3.6%, 95% CI 2.3-5.7 vs. 3.0%, 95% CI 1.7-5.3%). The pooled pancreatitis rate was higher with the forward-viewing endoscope (5.4%, 95% CI 3.6-8.0 vs. 2.5%, 95% CI 2.3-5.7%). The pooled bleeding rate was higher with the forward-viewing endoscope (3.0%, 95% CI 1.6-5.5 vs. 2.0%, 95% CI 1.4-3.0%). The heterogeneity among the studies was not significant. The publication bias was minimal.
CONCLUSION
This meta-analysis indicates that the forward-viewing endoscope is as safe and effective as conventional side-viewing endoscope for ERCP in patients with Billroth II gastrectomy.
Topics: Cholangiopancreatography, Endoscopic Retrograde; Endoscopes; Equipment Design; Gastroenterostomy; Humans; Postoperative Complications
PubMed: 29777352
DOI: 10.1007/s00464-018-6213-1 -
United European Gastroenterology Journal Feb 2020Endoscopic papillectomy (EP) is a viable therapy in ampullary lesions (AL). Many series have reported low morbidity and acceptable outcomes. We performed a systematic...
Endoscopic papillectomy (EP) is a viable therapy in ampullary lesions (AL). Many series have reported low morbidity and acceptable outcomes. We performed a systematic review with pooled analysis to assess the safety and efficacy of EP for AL. Electronic databases (Medline, Scopus and EMBASE) were searched up to September 2018. Studies that included patients with endoscopically resected AL were eligible. The rate of adverse events (AEs; primary outcome) and the rates of both technical and clinical efficacy outcomes were pooled by means of a random- or fixed-effects model to obtain a proportion with a 95% confidence interval (CI). Twenty-nine studies were included (1751 patients). The overall AE rate was 24.9%. The post-procedural pancreatitis rate was 11.9%, with the only factor affecting this outcome being prophylactic pancreatic stenting. The complete resection rate was 94.2%, with a rate of oncologically curative resection of 87.1%. The recurrence rate was 11.8% (follow-up: 9.6-84.5 months). EP is a relatively safe and effective option for AL. Our study might definitively suggest the protective role of prophylactic pancreatic stenting against post-procedural pancreatitis.
Topics: Adenoma; Ampulla of Vater; Asymptomatic Diseases; Common Bile Duct Neoplasms; Endoscopy, Digestive System; Follow-Up Studies; Humans; Neoplasm Recurrence, Local; Pancreatitis; Postoperative Complications; Stents; Treatment Outcome
PubMed: 32213054
DOI: 10.1177/2050640619868367 -
American Journal of Infection Control Jun 2018Bacterial culture is the accepted standard to measure the adequacy of high-level disinfection (HLD) of duodenoscopes. Adenosine triphosphate (ATP) bioluminescence assays... (Comparative Study)
Comparative Study
BACKGROUND
Bacterial culture is the accepted standard to measure the adequacy of high-level disinfection (HLD) of duodenoscopes. Adenosine triphosphate (ATP) bioluminescence assays have been suggested as an alternative method of evaluating the quality of reprocessing. We systematically reviewed published research describing the correlation between ATP and bacterial cultures.
METHODS
The primary outcome was the correlation or concordance between concomitantly sampled ATP and bacterial contamination obtained from the instrument channel and/or elevator mechanism of the duodenoscope. A secondary outcome included the reduction in ATP measurements between paired samples before and after stages of duodenoscope reprocessing.
RESULTS
Ten studies were included in the analysis. Four studies reported the relationship between concomitantly sampled ATP and cultures. Three studies reported receiver operating characteristic curves (1 study additionally reported a Wilcoxon rank sum test), and 1 study reported Spearman correlation coefficients and paired dichotomous measurements of ATP and bacterial contamination. All analyses suggested a poor relationship between the 2 measures. Studies measuring ATP before and after manual cleaning and before and after HLD reported a reduction in ATP after the reprocessing stage.
CONCLUSION
Current research does not support the direct substitution of ATP for bacterial culture surveillance of duodenoscopes. Serial ATP measurement may be a useful tool to evaluate the adequacy of manual cleaning and for training of endoscopic reprocessing staff.
Topics: Adenosine Triphosphate; Bacteria; Bacteriological Techniques; Cholangiopancreatography, Endoscopic Retrograde; Duodenoscopes; Equipment Contamination; Luminescent Measurements
PubMed: 29395506
DOI: 10.1016/j.ajic.2017.12.007 -
Journal of Gastroenterology and... Apr 2019Outbreaks of carbapenemase-producing Enterobacteriaceae clinical infections related to endoscopic transmission are well documented. The high morbidity and mortality...
Outbreaks of carbapenemase-producing Enterobacteriaceae clinical infections related to endoscopic transmission are well documented. The high morbidity and mortality associated with these infections emphasizes the need to reassess endoscopic reprocessing protocols. The Gastroenterological Society of Australia established a multi-society committee to formulate evidence-based consensus statements on the prevention and management of endoscopic transmission of carbapenemase-producing Enterobacteriaceae. A literature search was undertaken utilizing the MEDLINE database. Further references were sourced from published paper bibliographies. Nine statements were formulated. Using the Delphi methodology, the statements were initially reviewed electronically by the committee members and subsequently at a face-to-face meeting in Melbourne, Australia. After further discussion, four additional sub-statements were added resulting in a total of 13 statements. Each statement was assessed for level of evidence, recommendation grade and the voting on recommendation was recorded. For a statement to be accepted, five out of six committee members had to "accept completely" or "accept with some reservation." All 13 statements achieved consensus agreement. Eleven statements achieved 100% "accepted completely." Two statements were 83% "accepted completely" and 17% "accepted with some reservation." Of particular significance, automated flexible endoscope reprocessors were mandated for high-level disinfection, and the use of forced-air drying cabinets was mandated for endoscope storage. These evidence-based statements encourage preventative strategies with the aim of ensuring the highest possible standards in flexible endoscope reprocessing thereby optimizing patient safety. They must be considered in addition to the broader published guidelines on infection control in endoscopy.
Topics: Australia; Bacterial Proteins; Consensus; Databases, Bibliographic; Disinfection; Endoscopy, Gastrointestinal; Enterobacteriaceae; Enterobacteriaceae Infections; Evidence-Based Medicine; Female; Humans; Infection Control; Male; Pliability; Practice Guidelines as Topic; beta-Lactamases
PubMed: 30345549
DOI: 10.1111/jgh.14511 -
Digestive and Liver Disease : Official... Feb 2022
Topics: Cholangiopancreatography, Endoscopic Retrograde; Cross Infection; Disposable Equipment; Duodenoscopes; Equipment Contamination; Humans; Treatment Outcome
PubMed: 34838478
DOI: 10.1016/j.dld.2021.11.003