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Jornal de Pediatria 2023Meckel diverticulum (MD) is a common malformation of the digestive tract, often accompanied by serious complications. It is important to find safe and effective... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Meckel diverticulum (MD) is a common malformation of the digestive tract, often accompanied by serious complications. It is important to find safe and effective diagnostic methods for screening MD. The aim of this study was to evaluate the effectiveness of a technetium-99m (Tc-99m) scan for pediatric bleeding MD.
METHODS
The authors conducted a systematic review of studies published in PubMed, Embase, and Web of Science before 1 January 2023. Studies based on PICOS were included in this systematic review. The flow chart was made by PRISMA software. The quality of included studies was assessed by RevMan5 software (QUADAS-2: Quality Assessment of Diagnostic Accuracy Studies-2). The sensitivity, specificity, and other measurements of accuracy were pooled using Stata/SE 12.0 software.
RESULTS
Sixteen studies with 1115 children were included in this systematic review. A randomized-effects model was used for the meta-analysis because of significant heterogeneity. The combined sensitivity and specificity were 0.80 [Confidence Interval (95% CI, 0.73-0.86) and 0.95 (95% CI, 0.86-0.98)], respectively. The area under the curve (AUC) was 0.88 (95% CI, 0.85-0.90). Publication bias (Begg's test p = 0.053) was observed.
CONCLUSION
Tc-99m scan has high specificity, but moderate sensitivity, which is always influenced by some factors. Hence, the Tc-99m scan has some limitations in the diagnosis of pediatric bleeding MD.
Topics: Child; Humans; Technetium; Meckel Diverticulum; Radionuclide Imaging; Gastrointestinal Hemorrhage; Sensitivity and Specificity
PubMed: 37277097
DOI: 10.1016/j.jped.2023.03.009 -
Journal of Gastroenterology and... Jul 2023The role of the microbiota in diverticulosis and diverticular disease is underexplored. This systematic review aimed to assess all literature pertaining to the... (Review)
Review
BACKGROUND AND AIMS
The role of the microbiota in diverticulosis and diverticular disease is underexplored. This systematic review aimed to assess all literature pertaining to the microbiota and metabolome associations in asymptomatic diverticulosis, symptomatic uncomplicated diverticular disease (SUDD), and diverticulitis pathophysiology.
METHODS
Seven databases were searched for relevant studies published up to September 28, 2022. Data were screened in Covidence and extracted to Excel. Critical appraisal was undertaken using the Newcastle Ottawa Scale for case/control studies.
RESULTS
Of the 413 papers screened by title and abstract, 48 full-text papers were reviewed in detail with 12 studies meeting the inclusion criteria. Overall, alpha and beta diversity were unchanged in diverticulosis; however, significant changes in alpha diversity were evident in diverticulitis. A similar Bacteroidetes to Firmicutes ratio compared with controls was reported across studies. The genus-level comparisons showed no relationship with diverticular disease. Butyrate-producing microbial species were decreased in abundance, suggesting a possible contribution to the pathogenesis of diverticular disease. Comamonas species was significantly increased in asymptomatic diverticulosis patients who later developed diverticulitis. Metabolome analysis reported significant differences in diverticulosis and SUDD, with upregulated uracil being the most consistent outcome in both. No significant differences were reported in the mycobiome.
CONCLUSION
Overall, there is no convincing evidence of microbial dysbiosis in colonic diverticula to suggest that the microbiota contributes to the pathogenesis of asymptomatic diverticulosis, SUDD, or diverticular disease. Future research investigating microbiota involvement in colonic diverticula should consider an investigation of mucosa-associated microbial changes within the colonic diverticulum itself.
Topics: Humans; Diverticulum, Colon; Diverticulosis, Colonic; Microbiota; Diverticulitis; Diverticular Diseases
PubMed: 36775316
DOI: 10.1111/jgh.16142 -
Annals of Translational Medicine Jul 2022Cesarean sections are increasingly likely to be applied; however, uterine scar defects (USD) often remain after delivery. The two existing treatment methods,...
A systematic review and meta-analysis of the efficacy and safety of hysteroscopic electric resection versus vaginal surgery in the treatment of uterine scar defects after cesarean section.
BACKGROUND
Cesarean sections are increasingly likely to be applied; however, uterine scar defects (USD) often remain after delivery. The two existing treatment methods, hysteroscopic electric resection and vaginal surgery, are still controversial in terms of efficacy and safety. So, this paper to compares the effectiveness and safety of hysteroscopic electric resection and vaginal surgery in the treatment of USD after cesarean section.
METHODS
We performed a related literature search from main databases. According to the PICOS principles inclusion criteria were adult female USD patients to evaluate the efficacy of hysteroscopic resection and vaginal surgery for the treatment of USD, outcome data could be extracted to compare the efficacy and safety of the two procedures. Subsequently, according to the titles, abstracts, and full texts of the retrieved articles, studies that did not meet the inclusion criteria were eliminated. The RevMan 5.20 software was used for meta-analysis and Cochrane Risk of Bias 2 (RoB 2.0) was used to assess the risk of bias. The effectiveness and safety of hysteroscopic resection and vaginal surgery in the treatment of USD patients after cesarean section were compared.
RESULTS
Eight articles were finally included, with a total of 191 patients in the hysteroscopic electric resection group and 212 patients in the vaginal surgery group. Compared with hysteroscopic resection and vaginal surgery, there is less intraoperative blood loss [mean difference (MD) is -25.23, P<0.00001], shorter operation time (MD is -29.45, P<0.00001), and shorter hospital stay (MD is -1.87, P<0.00001), but menstrual improvement risk ratio (RR) is 0.71 (P=0.51) and diverticulum recovery RR is 0.60 (P=0.43) there were no significant differences.
DISCUSSION
Hysteroscopic electric resection provides a more satisfactory outcome than vaginal surgery in terms of intraoperative blood loss, operation time, and hospital stay. However, the sample size of the study was not large enough and some studies had high risk of bias, more large-sample multi-center high quality studies are needed for further comprehensive comparative analysis.
PubMed: 35965788
DOI: 10.21037/atm-22-2916 -
Journal of Vascular Surgery Feb 2023Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life... (Review)
Review
BACKGROUND
Aberrant subclavian artery (AScA) with or without associated Kommerell's diverticulum (KD) is the most frequently encountered anomaly of the aortic arch, it may be life threatening, especially when associated with aneurysmal degeneration. The best management is still debated and depends on many clinical and anatomical factors. A systematic review was conducted to assess the current evidence on the treatment options and their efficacy and safety for AscA and KD repairs.
METHODS
A literature search in PubMed and Cochrane Library was performed, and articles that were published from January 1947 to August 2021 reporting on AscA and KD management were identified. Multicenter studies, single-center series, and case series with three or more patients were considered eligible in the present review. A comparison of outcomes of patients who underwent open surgery (OS), a hybrid approach (HA), and total endovascular repair (ER) (ie, 30-day mortality and stroke were analyzed when available and compared among the three groups (P < .05; Benjamini and Hochberg-adjusted P < .05; Bonferroni-adjusted P < .05). Titles, abstracts, and full texts were evaluated by two authors independently. Primary outcomes included survival rate, perioperative stroke, arm ischemia, and spinal cord ischemia. Endoleak, in the case of HA and ER, and reintervention rates were considered outcomes.
RESULTS
Three hundred thirty-one articles were initially evaluated and 30 studies, totaling 426 patients treated for AScA with 324 KD, were included. Of the 426 patients, 241 were male (56.5%), and the mean patient age was 57.9 ± 12.0 years. The approach was OS in 228 patients, HA in 147 patients, and ER in 51. Dysphagia was the most common presentation in 133 cases. Aortic rupture was observed in 16 of the 426 patients (3.8%), including 14 AScA/KD (3.3%) aneurysm rupture. KD maximum diameter varied widely from 12.6 to 63.6 mm. The overall 30-day mortality was 20 (4.7%) (OS group 8/228 [3.5%]; HA group 10/147 [6.8%]; ER 2/51 [3.9%]; P = NS). The overall stroke rate was 4.9% (21/426) (OS group 10/228 [4.4%]; HA group 6/147 [4.1%]; ER group 5/51 [9.8%]; P = NS), including nine transient and nondisabling neurological deficits. Overall secondary procedures for complications were reported in 36 of the 426 cases (8.4%), mostly owing to endoleak. Follow-up varied from 13 to 74 months.
CONCLUSIONS
This systematic review assessed the current outcomes of the three types of therapeutic management for AScA and KD and demonstrated that they are all relatively safe and effective, providing satisfactory early and midterm outcomes. Long-term outcomes are warranted, especially for total ERs since the long-term durability of stent grafts remains unknown.
Topics: Humans; Male; Middle Aged; Aged; Female; Endoleak; Aorta, Thoracic; Subclavian Artery; Aortic Rupture; Endovascular Procedures; Diverticulum; Treatment Outcome
PubMed: 35850164
DOI: 10.1016/j.jvs.2022.07.010 -
European Journal of Vascular and... May 2022To synthesise and present all available evidence regarding the surgical treatment of patients with aberrant subclavian artery (aSA) pathologies during the last 30 years.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To synthesise and present all available evidence regarding the surgical treatment of patients with aberrant subclavian artery (aSA) pathologies during the last 30 years. The study also aimed to create a checklist of suggested reporting items to help increase reporting homogeneity.
METHODS
A systematic search of medical databases was performed to identify all studies published between 1990 and 2020 reporting on the outcomes of patients undergoing surgery for an aSA pathology. Patients were divided into two groups; Group A included patients undergoing open or hybrid surgery through sternotomy/thoracotomy and Group B included patients undergoing endovascular or hybrid treatment without chest access. The % crude rates (CR) of all variables of interest were calculated. A proportion meta-analysis was performed reporting pooled rates with 95% confidence intervals (CIs).
RESULTS
Three hundred and fourteen studies were identified reporting on the surgical outcomes of 732 patients (60.1% males; 440/732). The quality of evidence was generally low, with 286 studies including fewer than four patients and 28 studies with five or more cases. Aberrant right subclavian artery (aRSA) in a left sided aortic arch was present in 71.4% of the patients and a Kommerell's diverticulum was present in 50.1% of the cases. A total of 68% of the patients were symptomatic on presentation, with the majority complaining of dysphagia (49.6%). Group A included 453 and Group B 279 patients. Studies reporting on five or more patients were included in the main meta-analysis. The pooled early mortality rate was 1.62% (95% CI 0.05% - 4.53%) in Group A and 1.96% (95% CI 0 - 6.34%) in Group B. Pooled rates of symptom relief were 99.52% (95% CI 92.05% - 100.00%) in Group A and 95.79% (95% CI 83.96% - 100.00%) in Group B.
CONCLUSION
The surgical techniques used to treat aSA and aortic pathologies involving an aSA had remarkably low mortality rates and high clinical success, regardless of the technique used.
Topics: Aorta, Thoracic; Cardiovascular Abnormalities; Diverticulum; Female; Humans; Male; Subclavian Artery
PubMed: 35459610
DOI: 10.1016/j.ejvs.2022.02.027 -
Surgery Open Science Apr 2022Clinicopathological characteristics of intraductal papillary mucinous neoplasm derived from the ectopic pancreas have not been elucidated owing to its rarity. (Review)
Review
BACKGROUND
Clinicopathological characteristics of intraductal papillary mucinous neoplasm derived from the ectopic pancreas have not been elucidated owing to its rarity.
METHODS
MEDLINE databases from 1985 to 2021 were searched. Data regarding patient characteristics, diagnostic modalities, treatment, and prognosis were extracted from the identified articles.
RESULTS
Comprehensive data on 13 patients (10 men and 3 women) with intraductal papillary mucinous neoplasm derived from ectopic pancreas were extracted. The median age was 69 years (range, 42-80 years). The tumors were located in the stomach in 6 patients, the duodenum in 1 patient, jejunum in 3 patients, ileum in 1 patient, and Meckel diverticulum in 2 patients. Histopathological examination revealed intraductal papillary mucinous neoplasm in 10 patients and intraductal papillary mucinous carcinoma in 3 patients. The median size of the tumor was not significantly different between the intraductal papillary mucinous carcinoma group and the intraductal papillary mucinous neoplasm group (P = .611).
CONCLUSION
Accurate preoperative diagnosis and differential diagnosis between intraductal papillary mucinous neoplasm and intraductal papillary mucinous carcinoma remain difficult despite recent advances in imaging modalities.
PubMed: 35392578
DOI: 10.1016/j.sopen.2022.03.001 -
Annals of Pediatric Surgery 2022Perforation of Meckel Diverticulum (MD) is a rare cause of pneumoperitoneum in neonates. We hereby report six cases of perforation of MD in neonates, with addition of 53...
BACKGROUND
Perforation of Meckel Diverticulum (MD) is a rare cause of pneumoperitoneum in neonates. We hereby report six cases of perforation of MD in neonates, with addition of 53 cases from systematic review of the literature. A systematic review was performed using Mesh terms "Neonate, Meckel Diverticulum, Perforation, Pneumoperitoneum." All reports of perforated MD in the English literature were identified. Details of our 6 cases were analyzed in similar fashion.
RESULTS
A total of 3027 manuscripts were screened and 59 cases including 6 of our own were identified. The vast majority (78%) were female. Fifty patients (84.7%) presented in the newborn period. Half of the cases (52.5%) had associated anomalies and 13 neonates (22%) required oxygen supplementation including CPAP or ventilatory support before surgery. In 73% of the cases, a resection of gut was undertaken. Histopathological assessment in 44 cases (74.6%) revealed no ectopic gastric mucosa. Three cases demised prior to treatment. The outcome in the vast majority was excellent with 84.7% surviving and discharged well.
CONCLUSION
Perforated MD is an unusual cause of a pneumoperitoneum in the newborns. Diagnosis is established at laparotomy and it rare to find ectopic mucosa histopathologically. The overall outcome is excellent.
PubMed: 35281619
DOI: 10.1186/s43159-021-00154-z -
BMC Pediatrics Dec 2021While necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admitted to neonatal intensive care unit (NICU), intussusception is exceedingly...
BACKGROUND
While necrotizing enterocolitis (NEC) is a prevalent condition in preterm neonates admitted to neonatal intensive care unit (NICU), intussusception is exceedingly uncommon and often overlooked. This is due to the fact that they share many clinical characteristics. The initial misdiagnosis of intussusception in preterm neonates (IPN) especially has led to a delay in their management, which increases the risk of developing compromised bowel. Additionally, it is difficult to reach a diagnosis as neonatal intussusception does not have any classical radiological signs even when contrast enema is used. This systematic review is based on the published literature including case reports and case series to review the clinical features of IPN and how to differentiate it from NEC in order to shed the light on this rare disease and how having a high index of suspicion would help practitioners to make an early and accurate diagnosis METHODS: A systematic literature search to report all cases of relevant articles that reported IPN till date. All cases that were born before 37 weeks gestational age, presented within the neonatal period and having well established documentation were included in the study. Any case that did not have these criteria was excluded from our study.
RESULTS
Only 52 cases met these criteria during the period from 1963 till date. An average of 10 days had elapsed before the cases were confirmed to have IPN either clinically or intraoperatively. The most frequent manifestations were abdominal distension and bilious gastric residuals, occurring in 85% and 77% of the cases respectively, followed by bloody stools in 43% of cases. However, this triad was present only in approximately one-third of the cases. Only 13 cases were diagnosed as having intussusception preoperatively. About two thirds of the intussusception were located in the ileum. Pathological lead point was present in 7 cases only; 4 of them were due to Meckel's diverticulum. Nine cases only out of the 52 cases with IPN died.
CONCLUSION
It is crucial to detect the clues for diagnosis of intussusception because in contrast to NEC, it is unresponsive to conservative management, affects the viability of the bowel and surgery is essential.
Topics: Enterocolitis, Necrotizing; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intussusception; Rare Diseases
PubMed: 34952564
DOI: 10.1186/s12887-021-03065-5 -
Minerva Urology and Nephrology Aug 2022Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with...
INTRODUCTION
Colovesical fistulas (CVFs) account for approximately 95% enterovesical fistulas (EVFs). About 2/3 CVF cases are diverticular in origin. It mainly presents with urological signs such as pneumaturia and fecaluria. Diagnostic investigations aim at confirming the presence of a fistula. Although conservative management can be chosen for selected individuals, most patients are mainly treated through surgical interventions. CVF represents a challenging condition, which records high rates of morbidity and mortality. Our systematic review aimed at achieving deeper knowledge of both indications, in addition to short- and long-term outcomes related to CVF management.
EVIDENCE ACQUISITION
We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Pubmed/MEDLINE, Embase, Scopus, Cochrane Library and Web of Science databases were used to search all related literature.
EVIDENCE SYNTHESIS
The 22 included articles covered an approximately 37 years-study period (1982-2019), with a total 1365 patient population. CVF etiology was colonic diverticulitis in most cases (87.9%). Pneumaturia (50.1%), fecaluria (40.9%) and urinary tract infections (46.6%) were the most common symptoms. Abdomen computed tomography (CT) scan (80.5%), colonoscopy (74.5%) and cystoscopy (55.9%) were the most frequently performed diagnostic methods. Most CVF patients underwent surgery (97.1%) with open approach (63.3%). Almost all patients had colorectal resection with primary anastomosis with or without ostomy and 53.2% patients underwent primary repair or partial/total cystectomy. Four percent anastomotic leak, 1.8% bladder leak and 3.1% reoperations rates were identified. In an average 5-68-month follow-up, overall morbidity, overall mortality and recurrences rates recorded were 8-49%, 0-63% and 1.2%, respectively.
CONCLUSIONS
CVF mainly affects males and has diverticular origin in almost all cases. Pneumaturia, fecaluria and urinary tract infections are the most characteristic symptoms. Endoscopic tests and imaging are critical tools for diagnostic completion. Management of CVFs depends on the underlying disease. Surgical treatment represents the final approach and consists of resection and reanastomosis of offending intestinal segment, with or without bladder closure. In many cases, a single-stage surgical strategy is selected. Perioperative and long-term outcomes prove good.
Topics: Colon, Sigmoid; Colonoscopy; Diverticulitis, Colonic; Diverticulum; Humans; Intestinal Fistula; Male; Urinary Bladder Fistula
PubMed: 34791866
DOI: 10.23736/S2724-6051.21.04750-9 -
Journal of Clinical GastroenterologyThere is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula. (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is limited evidence on the efficacy of peroral endoscopic myotomy (POEM) in patients with esophageal diverticula.
AIMS
This meta-analysis aimed to assess the efficacy and safety profile of POEM in patients with Zenker (ZD) and epiphrenic diverticula.
METHODS
With a literature search through August 2020, we identified 12 studies (300 patients) assessing POEM in patients with esophageal diverticula. The primary outcome was treatment success. Results were expressed as pooled rates and 95% confidence intervals.
RESULTS
Pooled rate of technical success was 95.9% (93.4%-98.3%) in ZD patients and 95.1% (88.8%-100%) in patients with epiphrenic diverticula. Pooled rate of treatment success was similar for ZD (90.6%, 87.1%-94.1%) and epiphrenic diverticula (94.2%, 87.3%-100%). Rates of treatment success were maintained at 1 year (90%, 86.4%-97.4%) and 2 years (89.6%, 82.2%-96.9%) in ZD patients. Pooled rate of symptom recurrence was 2.6% (0.9%-4.4%) in ZD patients and 0% in patients with epiphrenic diverticula. Pooled rates of adverse events and severe adverse events were 10.6% (4.6%-16.6%) and 3.5% (0%-7.4%) in ZD and 8.4% (0%-16.8%) and 8.4% (0%-16.8%) in epiphrenic diverticula, respectively.
CONCLUSION
POEM represents an effective and safe therapy for the treatment of esophageal diverticula.
Topics: Digestive System Surgical Procedures; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Sphincter, Lower; Humans; Myotomy; Natural Orifice Endoscopic Surgery; Treatment Outcome
PubMed: 34608024
DOI: 10.1097/MCG.0000000000001622