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Therapeutics and Clinical Risk... 2019To compare endoscopic papillary large balloon dilation (EPLBD) alone with EPLBD following endoscopic sphincterotomy (EST) in patients with large and/or multiple common... (Review)
Review
Comparison of endoscopic papillary large balloon dilation with and without a prior endoscopic sphincterotomy for the treatment of patients with large and/or multiple common bile duct stones: a systematic review and meta-analysis.
AIM
To compare endoscopic papillary large balloon dilation (EPLBD) alone with EPLBD following endoscopic sphincterotomy (EST) in patients with large and/or multiple common bile duct stones.
METHODS
We conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library database to identify relevant available articles until July 19, 2018. Complete common bile duct stone (CBDS) removal rate, frequency of mechanical lithotripsy (ML) usage, total procedure time and intra- and postoperative adverse events were analyzed. We used RevMan 5.3 to perform the pooled analyses.
RESULTS
Seven RCTs matched the selection criteria. A total of 369 patients underwent EPLBD alone, and 367 patients underwent EPLBD following EST. Our meta-analysis revealed that there were no significant differences in terms of initial success rate (OR =0.69, 95% CI=0.44-1.09, =0.11), frequency of ML usage (OR =1.18, 95% CI=0.68-2.05, =0.55), rate of post-endoscopy pancreatitis (PEP) (OR =0.88, 95% CI=0.43-1.78, =0.72), total procedure time (MD =1.52, 95% CI=-0.13-3.17, =0.07), or other intra- and postoperative adverse events between the groups for patients with large and/or multiple CBDSs.
CONCLUSIONS
EPLBD alone was comparable to EPLBD with prior EST in patients with large and/or multiple CBDSs. Further studies are required to confirm the mechanisms of PEP in patients who accept EPLBD during endoscopic retrograde cholangiopancreatography (ERCP).
PubMed: 30666119
DOI: 10.2147/TCRM.S182615 -
Annals of Vascular Surgery Nov 2022For arteriovenous fistula (AVF) presence of a venous segment with adequate diameter is essential which is lacking in many patients. To find the optimal augmentation... (Meta-Analysis)
Meta-Analysis Review
Primary Balloon Angioplasty Versus Hydrostatic Dilation for Arteriovenous Fistula Creation in Patients with Small-Caliber Cephalic Veins: A Systematic Review and Meta-Analysis.
BACKGROUND
For arteriovenous fistula (AVF) presence of a venous segment with adequate diameter is essential which is lacking in many patients. To find the optimal augmentation technique in patients with small-caliber cephalic vein (i.e., cephalic vein diameter <3 mm), studies compared primary balloon angioplasty (PBA) versus hydrostatic dilation (HD); however, it remained debatable. This systematic review seeks to determine which technique is preferable.
METHODS
We searched MEDLINE, PubMed, Embase, and Google Scholar. Primary outcomes were 6-month primary patency, reintervention, and working AVF. Secondary outcomes were immediate success, the AVF's maturation time (day), and surgical site infection.
RESULTS
Three randomized controlled trials yielding 180 patients were included, of which 89 patients were in the PBA group. The odds ratio (OR) of primary patency was significantly higher in the PBA group (OR 6.09, 95% confidence interval [CI], 2.36-15.76, P = 0.0002), the OR of reintervention was significantly lower in the PBA group (OR 0.16, 95% CI, 0.06-0.42, P = 0.0002), and the OR of working AVF was greater in PBA group (OR 4.22, 95% CI, 1.31-13.59, P = 0.02). The OR of immediate success was significantly greater in the PBA group (OR 11.42, 95% CI, 2.54-51.42, P = 0.002), and the AVF maturation time was significantly shorter in patients who underwent PBA (mean difference -20.32 days, 95% CI, -30.12 to -10.52, P = 0.0001). The certainty of the evidence was high.
CONCLUSIONS
PBA of small cephalic veins with diameter ≤2.5 cm is a safe, feasible, and efficacious augmentation method for AVF creation. This technique achieves favorable maturation outcomes, and PBA is superior to the standard hydrostatic dilatation technique.
Topics: Humans; Arteriovenous Shunt, Surgical; Dilatation; Renal Dialysis; Treatment Outcome; Angioplasty, Balloon; Arteriovenous Fistula; Dilatation, Pathologic; Vascular Patency; Randomized Controlled Trials as Topic
PubMed: 36029949
DOI: 10.1016/j.avsg.2022.07.025 -
Cureus Jun 2023Tracheal stenosis (TS) is an iatrogenic sequela after intubation or tracheostomy that is increasing despite technological improvement and skilled respiratory care in the... (Review)
Review
Tracheal stenosis (TS) is an iatrogenic sequela after intubation or tracheostomy that is increasing despite technological improvement and skilled respiratory care in the ICU. According to the studies, the rate of TS varies from 10 to 22%, but only 1-2% of these stenoses are severe and present with inspiratory dyspnea that does not respond to medical management. Bronchoscopy is considered the most appropriate diagnostic test, and laser surgery and tracheobronchial stenting are the most commonly performed procedures for tracheal stenosis. However, alternative treatment options, including cryotherapy for inoperable patients, have yet to be studied widely. As the number of patients requiring ICU admission with mechanical intubation is increasing, it is crucial to acknowledge this complication and consider alternative management options. Here we present a review of the use of cryotherapy for post-intubation tracheal stenosis. Pubmed, Cochrane, and EMBASE databases were inquired for studies performed using the keywords 'airway stricture' OR 'airway obstruction' AND 'post-intubation' OR 'post-extubation' OR 'tracheostomy' AND 'cryotherapy'. After the primary and secondary screening, five studies were included in the analysis. We included 67 patients were included in the analysis, with a mean age of 50.2 (range: 42-55) years. Tracheal stenosis and subglottic stricture were the most common sites of stenosis. Twenty-nine patients were treated with cryotherapy only, while the rest 38 patients had cryotherapy followed by balloon dilation. After the intervention, 48 patients experienced improvement, five experienced no change in the symptoms, 13 patients were asymptomatic before the treatment, and one died. No complication was reported in 65 patients, with only minor complications reported in rest. Although, there is no clear treatment protocol for patients with inoperable tracheal stenosis. Our review demonstrates that cryotherapy for inoperable tracheal stenosis can be an acceptable alternative treatment with significant clinical improvement. Additionally, cryotherapy has fewer adverse effects compared to other treatment options.
PubMed: 37519508
DOI: 10.7759/cureus.41012 -
Journal of Vascular Surgery Feb 2008The goal of this study was to review the currently available literature and to compare the short and long-term results of primary stenting and angioplasty of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The goal of this study was to review the currently available literature and to compare the short and long-term results of primary stenting and angioplasty of femoropopliteal occlusive disease by performing a meta-analysis review.
METHODS
A systematic review of the literature that was published between September 2000 and January 2007 was performed. All studies that reported data on the long-term results after balloon dilatation or stent implantation were included if at least one-year primary patency or restenosis rate was presented; the study follow-up was at least 1 year and the number of subjects at the start of study was at least 20 patients. Three investigators independently extracted the data. The Pooled survival curves were then constructed for graft patency according to a random-effects protocol for meta-analysis.
RESULTS
Twenty-four articles were initially identified but only seven were selected and included in this meta-analysis: seven were RCTs publications and one was a retrospective study comparing the outcome of angioplasty and stenting of the femoropopliteal segment. In our meta-analysis, there were a total of 934 patients with 452 patients who underwent balloon angioplasty (273 patients were male) and 482 patients who underwent stenting (297 patients were male). Primary patency at 1-year and postoperative ABI post intervention was used to evaluate the pooled odds ratio (OR) of all studies. The pooled OR of all studies estimate for the 12-month patency rates was 0.989 (95% confidence interval [CI], 0.623 to 1.570, P = .962) showing no difference in outcome between the two groups (SE 0.269% to 1.025%). The pooled OR estimate for the postoperative ABI was 0.869 (95% CI, 0.557 to 1.357, P = .561) showing a slight advantage in favor of the angioplasty group but the P value was not statistically significant (SE 0.282% to 1.326%). The 1-year primary patency rates following balloon angioplasty ranged from 45% to 84.2% and at 2 years it varied from 25% to 77.2%. In the stent implantation group, the 1-year primary patency rates varied from 63% to 90%, and 2-year primary patency ranged from 46% to 87%. Heterogeneity was seen among studies, and publication bias could not be excluded.
CONCLUSIONS
The results of our meta-analysis suggest that stent placement in the femoropopliteal occlusive disease does not increase the patency rate when compared with angioplasty alone at 1 year. This conclusion should be viewed in the light of study-design considerations and all limitations in this meta-analysis that may have an impact of the outcome of stenting and angioplasty after a 1-year follow-up.
Topics: Angioplasty, Balloon; Ankle; Arterial Occlusive Diseases; Blood Pressure; Brachial Artery; Constriction, Pathologic; Female; Femoral Artery; Humans; Male; Odds Ratio; Popliteal Artery; Prosthesis Failure; Recurrence; Risk Assessment; Stents; Time Factors; Treatment Outcome; Vascular Patency
PubMed: 17950563
DOI: 10.1016/j.jvs.2007.07.059 -
Frontiers in Pediatrics 2022Hepato-pancreato-biliary (HPB) disease has different causes and types between children and adults, which has been increasingly diagnosed in the pediatric group....
BACKGROUND
Hepato-pancreato-biliary (HPB) disease has different causes and types between children and adults, which has been increasingly diagnosed in the pediatric group. Endoscopic retrograde cholangiopancreatography (ERCP) has been gradually considered as a therapeutic method in adults, while in pediatric patients, there are not many reports of its usage. This systematic review and meta-analysis aims to assess the use condition of therapeutic ERCP in the management of pediatric HPB diseases.
METHODS
This systematic literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane library databases to identify all relevant articles published from inception to February 2022 that evaluated therapeutic ERCP in pediatric patients with HPB diseases. The researchers included studies in which patients were less than 18 years old and underwent therapeutic ERCP procedures. A random-effects model was used to analyze the usage rate of therapeutic ERCP procedures, procedural success rates, adverse event rates, and the rate of different therapeutic procedures. Subgroup analysis, sensitivity analysis, and meta-regression were conducted to analyze the source of heterogeneity.
RESULTS
A total of 33 articles were included. After homogenization, the overall use of therapeutic interventions accounts for 77% [95% confidence interval (CI) 74-81%] of all ERCP procedures. After excluding outlier studies, the estimation success rate of the therapeutic procedure is 74% (95% CI 69-79%), and adverse event rate is 8% (95% CI 6-10%). In our study, stent placement is the most common procedure, which makes up 75% (95% CI 65-86%) of all therapeutic procedures. In addition, the usage proportion of sphincterotomy (ST), stone extraction/removal, bougienage/balloon dilation is, respectively, 46% (95% CI 39-53%), 34% (95% CI 31-38%), and 26% (95% CI 22-29%).
CONCLUSION
The ERCP procedure is gradually considered a therapeutic technique in pediatric patients, the proportion of therapeutic ERCP is 77% of total usage, which is increasing every year. Meanwhile, its success rate is relatively high. It reflects that this operation modality is promising in the treatment of HPB disorders and is gradually expanded as more branch technologies are being used. A variety of operations can be achieved through ERCP procedures, and more functions should be developed in the future.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42022302911].
PubMed: 35844750
DOI: 10.3389/fped.2022.915085 -
Respiratory Care Nov 2014The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety.... (Review)
Review
BACKGROUND
The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety. Tracheostomy is the most common procedure performed on the airway for patients in ICUs. Lately, several methods of percutaneous tracheostomy (multiple dilator, progressive dilator, forceps dilation, screw-like dilation, balloon dilation, and translaryngeal) have been described, with theoretical advantages, but there is no consensus about which is better.
METHODS
A systematic review with critical appraisal of the literature was done. Literature in multiple databases was searched. Randomized controlled trials comparing different tracheostomy methods were selected. Clinical and methodological characteristics were assessed. A meta-analysis using fixed effect models was planned for statistically homogeneous outcomes.
RESULTS
Fourteen randomized controlled trials were included, most of them with small sample sizes and with comparisons of multiple methods. Blue Rhino methods were less difficult for surgeons (risk difference of 14.7% [95% CI 8-21.5]) and had more minor bleeding events (risk difference of -6.3% [95% CI -13.58 to 0.8]). There were no differences in major bleeding events. Statistically, heterogeneity and lack of data impede comparison with other outcomes.
CONCLUSIONS
The Blue Rhino method is less difficult and has more minor bleeding events, but physicians also have more experience with this technique. However, trials are underpowered to define the best method.
Topics: Critical Illness; Dilatation; Equipment Design; Humans; Tracheostomy
PubMed: 25185145
DOI: 10.4187/respcare.03050 -
Frontiers in Surgery 2019Therapeutic management of primary obstructive megaureter (POM) requiring surgery has been under debate for the last 15 years especially regarding the outcomes of...
Therapeutic management of primary obstructive megaureter (POM) requiring surgery has been under debate for the last 15 years especially regarding the outcomes of endoscopic techniques compared to most traditional approaches. This review aims to analyze endoscopic High-Pressure Balloon Dilatation (HPBD) using the IDEAL model, a five-stage framework that describes surgical innovations (Idea, Development, Exploration, Assessment, and Long-term Study) and provides recommendations for a rigorous stepwise surgical research pathway. This model has been developed and demonstrated its value in evaluating surgical innovations assessing data quality and providing relevant information for the optimal design and feasibility of research in surgery. A systematic review of the published series of endoscopic HPBD in patients with POM was done using the IDEAL model as a tool to assess evidence quality. Reported clinical outcomes are also analyzed and reviewed. The analysis of the results of the systematic assessment of the reported cohort of patients treated with HPBD for POM that the technique up to date is in stage 2a and stage 2b, or development. Evidence quality among the reported cohorts of patients with POM treated with HPBD is adequate, although systematization and standardization should be improved. Clinical outcomes of HPBD in the management of POM consistently show a 87.7% success rate with a negligible operative complication rate once "learning curve" has been surpassed. Symptomatic vesicoureteral reflux (VUR) is the main reason for ureteric reimplantation, but asymptomatic VUR does not seem to influence clinical outcome. The IDEAL framework and recommendations have allowed a systematic analysis of the evidence quality of the reported experience in the management of children with POM with HPBD of the vesicoureteral junction. The available evidence demonstrates that HPBD is an effective treatment for patients with POM, with a long-term success rate of 87.7% with very low morbidity. Future research mandates a standardization of data reporting, "ideally" following IDEAL recommendations, that would be required for any intervention and facilitate comparative analysis.
PubMed: 31058164
DOI: 10.3389/fsurg.2019.00020 -
Journal of Interventional Cardiology Jun 2017The aim of this study was to perform a meta-analysis to compare the outcomes of patients undergoing TAVR with and without balloon post-dilation (PD). (Review)
Review
OBJECTIVES
The aim of this study was to perform a meta-analysis to compare the outcomes of patients undergoing TAVR with and without balloon post-dilation (PD).
BACKGROUND
PD is a commonly used technique in TAVR to minimize paravalvular regurgitation (PVR), albeit supported by little evidence.
METHODS
Systematic review and meta-analysis of 6 studies comparing 889 patients who had PD compared to 4118 patients without PD.
RESULTS
Patients undergoing PD were more likely male (OR 1.92; 95% CI, 1.41-2.61; P < 0.001) and to have coronary artery disease (OR 1.31; 95% CI, 1.03-1.68; P = 0.03) than those patients not requiring PD. There were no significant differences in 30-day mortality (OR 1.24; 95% CI, 0.88-1.74; P = 0.22) and myocardial infarction (OR 0.93; 95% CI, 0.46-1.90; P = 0.85). Patients undergoing TAVR did not have higher 1-year mortality rates (OR 0.98; 95% CI, 0.61-1.56; P = 0.92). The incidence of stroke was significantly greater in patients with PD (OR, 1.71; 95% CI, 1.10-2.66). PD was able to reduce the incidence of moderate-severe PVR by 15 fold (OR 15.0; 95% CI, 4.2-54.5; P < 0.001), although rates of moderate-severe PVR were still higher after PD than patients who did not require PD (OR 3.64; 95% CI, 1.96-6.75; P < 0.001).
CONCLUSIONS
PD significantly improves rates of PVR, however careful patient selection is needed to minimize increased risk of strokes.
Topics: Aortic Valve Insufficiency; Aortic Valve Stenosis; Balloon Valvuloplasty; Heart Valve Prosthesis Implantation; Humans; Incidence; Outcome Assessment, Health Care; Postoperative Complications; Risk Factors; Transcatheter Aortic Valve Replacement
PubMed: 28321917
DOI: 10.1111/joic.12378 -
The Cochrane Database of Systematic... Oct 2006Endoscopic balloon dilation was introduced as an alternative to endoscopic sphincterotomy to preserve the sphincter of Oddi and avoid undesirable effects due to an... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Endoscopic balloon dilation was introduced as an alternative to endoscopic sphincterotomy to preserve the sphincter of Oddi and avoid undesirable effects due to an incompetent sphincter. Endoscopic balloon dilation has been largely abandoned by USA endoscopists due to increased risks of pancreatitis noted in one multicentre trial, but is still practiced in parts of Asia and Europe.
OBJECTIVES
To assess the beneficial and harmful effects of endoscopic balloon dilation versus endoscopic sphincterotomy in the management of common bile duct stones.
SEARCH STRATEGY
We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, and EMBASE until January 2004. We hand searched Gastrointestinal Endoscopy (1983-2002), read through bibliographies of all included randomised clinical trials, and contacted all primary authors regarding missed randomised trials.
SELECTION CRITERIA
Randomised clinical trials comparing endoscopic balloon dilation versus endoscopic sphincterotomy in removal of common bile duct stones irrespective of publication status, language, or blinding.
DATA COLLECTION AND ANALYSIS
Data collection was done by two independent authors for decisions on study inclusion, data abstraction, and quality assessment. When there was a non-resolvable discrepancy, the third author made the final decision. Analysis was run with RevMan Analysis.
MAIN RESULTS
Fifteen randomised trials met our inclusion criteria (1768 participants). Less than half of the trials reported adequate methods of randomisation and only two trials used blinded outcome assessment. Endoscopic balloon dilation is statistically less successful for stone removal (relative risk (RR) 0.90, 95% confidence interval (CI) 0.84 to 0.97), requires higher rates of mechanical lithotripsy (RR 1.34, 95% CI 1.08 to 1.66), and carries a higher risk of pancreatitis (RR 1.96, 95% CI 1.34 to 2.89). Conversely, endoscopic balloon dilation has statistically significant lower rates of bleeding. When a fixed-effect model is applied endoscopic balloon dilation leads to significantly less short-term infection and long-term infection. There was no statistically significant difference with regards to mortality, perforation, or total short-term complications.
AUTHORS' CONCLUSIONS
Endoscopic balloon dilation is slightly less successful than endoscopic sphincterotomy in stone extraction and more risky regarding pancreatitis. However, endoscopic balloon dilation seems to have a clinical role in patients who have coagulopathy, who are at risk for infection, and possibly in those who are older.
Topics: Catheterization; Gallstones; Humans; Randomized Controlled Trials as Topic; Sphincter of Oddi; Sphincterotomy, Endoscopic
PubMed: 17054222
DOI: 10.1002/14651858.CD004890.pub2 -
Alimentary Pharmacology & Therapeutics Jul 2015Extensive endoscopic resections for the treatment of early oesophageal neoplasia can result in fibro-inflammatory strictures that require repeated interventions, which... (Review)
Review
BACKGROUND
Extensive endoscopic resections for the treatment of early oesophageal neoplasia can result in fibro-inflammatory strictures that require repeated interventions, which significantly alter the patients' quality of life.
AIMS
To review current evidence about the prevention of oesophageal strictures following endoscopic resections.
METHODS
Systematic search of PubMed and Embase from inception to March 2015 using appropriate keywords. All original publications in English were included, and articles on the treatment of oesophageal stricture were excluded.
RESULTS
Of the 461 hits, 62 studies were included in the analysis. Among the wound-protective strategies, polyglycolic acid sheets showed the most convincing evidence with a 37.5% stricture rate and excellent safety. Regenerative medicine, using cell sheets of autologous keratinocytes, resulted in a 25% stricture rate, although with cost and availability concerns. Among anti-proliferative treatment modalities, steroid treatment, either endoscopically injected triamcinolone in the resection wound or orally administered prednisolone, proved effective with an overall stricture rate of 13.5%, with safety concerns regarding late oesophageal perforations and infectious morbidity. Among mechanical treatment options, poorly effective and high-risk preventive balloon dilation tend to be replaced by prophylactic covered stent, with 18-28% stricture rates.
CONCLUSIONS
Although oral or locally injected steroids are promising options, no currently available technique is sufficiently efficient and devoid of significant safety concerns to recommend its routine use for the prevention of strictures after extensive endoscopic resection. Improving our knowledge in the mechanisms of oesophageal wound healing will guide the development of novel methods for stricture prevention.
Topics: Esophageal Neoplasms; Esophageal Perforation; Esophageal Stenosis; Esophagoscopy; Humans; Quality of Life
PubMed: 25982288
DOI: 10.1111/apt.13254