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World Journal of Gastroenterology Jun 2018To compare endoscopic submucosal dissection (ESD) outcomes between Eastern and Western countries. (Comparative Study)
Comparative Study Review
AIM
To compare endoscopic submucosal dissection (ESD) outcomes between Eastern and Western countries.
METHODS
A systematic review and meta-analysis was performed using PubMed, MEDLINE, Web of Science, CINAHL and EBM reviews to identify studies published between 1990 and February 2016. The primary outcome was the efficacy of ESD based on information about either curative resection, or R0 resection rates. Secondary outcomes were complication rates, local recurrence rates and procedure times.
RESULTS
Overall, 238 publications including 84318 patients and 89512 gastrointestinal lesions resected using ESD were identified. 90% of the identified studies reporting ESD on 87296 lesions were conducted in Eastern countries and 10% of the identified studies reporting ESD outcomes in 2216 lesions were from Western countries. Meta-analyses showed higher pooled percentage of curative, , and R0 resection in the Eastern studies; 82% (CI: 81%-84%), 95% (CI: 94%-96%) and 89% (CI: 88%-91%) compared to Western studies; 71% (CI: 61%-81%), 85% (CI: 81%-89%) and 74% (CI: 67%-81%) respectively. The percentage of perforation requiring surgery was significantly greater in the Western countries (0.53%; CI: 0.10-1.16) compared to Eastern countries (0.01%; CI: 0%-0.05%). ESD procedure times were longer in Western countries (110 min 77 min).
CONCLUSION
Eastern countries show better ESD outcomes compared to Western countries. Availability of local ESD expertise and regional outcomes should be considered for decision making to treat gastrointestinal lesions with ESD.
Topics: Endoscopic Mucosal Resection; Esophageal Mucosa; Gastric Mucosa; Gastrointestinal Neoplasms; Humans; Intestinal Mucosa; Neoplasm Recurrence, Local; Operative Time; Postoperative Complications; Treatment Outcome
PubMed: 29930473
DOI: 10.3748/wjg.v24.i23.2518 -
Journal of Clinical Medicine May 2023The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral... (Review)
Review
BACKGROUND
The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords "ureteral stone", "ureteral calculus", "impacted stone", "ureteral stenosis", "ureteroscopic lithotripsy", "impacted calculus", and "ureteral strictures" singly or in combination.
RESULTS
After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures.
CONCLUSION
Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones.
PubMed: 37240709
DOI: 10.3390/jcm12103603 -
Journal of Spine Surgery (Hong Kong) Mar 2018We conducted a thorough review of the literature to examine the risks and complications associated with the use of Gardner-Wells Tongs (GWT). Twenty-three articles were... (Review)
Review
We conducted a thorough review of the literature to examine the risks and complications associated with the use of Gardner-Wells Tongs (GWT). Twenty-three articles were included in this review for final analysis. One article reported a 37.5% (6/16) incidence rate of minor complications with the usage of GWTs, which included pin loosening, asymmetrical pin positioning, and superficial infections. Various cases reported more serious yet rare complications, including perforation of the skull, brain abscesses, and neurovascular damage. Overall, the complication rate is low, and often associated with only minor and transient complications, which can be easily managed. Therefore, we conclude that GWT are safe and effective, with only rare, more serious complications reported in the literature.
PubMed: 29732432
DOI: 10.21037/jss.2018.03.03 -
World Journal of Gastroenterology Oct 2016To determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy (BAE) in Crohn's disease (CD). (Review)
Review
AIM
To determine the overall and comparative risk of procedure related perforation of balloon assisted enteroscopy (BAE) in Crohn's disease (CD).
METHODS
Systematic review (PROSPERO #CRD42015016381) of studies reporting on CD patients undergoing BAE. Seventy-three studies reporting on 1812 patients undergoing 2340 BAEs were included. Primary outcome of interest was the overall and comparative risk of procedure related perforation of diagnostic BAE in CD. Secondary outcomes of interest were risk of procedure related perforation of diagnostic double balloon enteroscopy (DBE), risk of procedure related perforation of therapeutic BAE, efficacy of stricture dilation, and clinical utility of endoscopically assessing small bowel disease activity.
RESULTS
Per procedure perforation rate of diagnostic BAE in CD was 0.15% (95%CI: 0.05-0.45), which was similar to diagnostic BAE for all indications (0.11%; IRR = 1.41, 95%CI: 0.28-4.50). Per procedure perforation rate of diagnostic DBE in CD was 0.12% (95%CI: 0.03-0.44), which was similar to diagnostic DBE for all indications (0.22%; IRR = 0.54, 95%CI: 0.06-0.24). Per procedure perforation rate of therapeutic BAE in CD was 1.74% (95%CI: 0.85-3.55). Eighty-six percent of therapeutic perforations were secondary to stricture dilation. Dilation was attempted in 207 patients and 30% required surgery during median follow-up of 18 months. When diagnostic BAE assessed small bowel disease activity, changes in medical therapy resulted in endoscopic improvement in 77% of patients.
CONCLUSION
Diagnostic BAE in CD has a similar rate of perforation as diagnostic BAE for all indications and can be safely performed in assessment of mucosal healing.
Topics: Balloon Enteroscopy; Crohn Disease; Humans
PubMed: 27833391
DOI: 10.3748/wjg.v22.i40.8999 -
The Cochrane Database of Systematic... Jun 2017Intussusception is a common abdominal emergency in children with significant morbidity. Prompt diagnosis and management reduces associated risks and the need for... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intussusception is a common abdominal emergency in children with significant morbidity. Prompt diagnosis and management reduces associated risks and the need for surgical intervention. Despite widespread agreement on the use of contrast enema as opposed to surgery for initial management in most cases, debate persists on the appropriate contrast medium, imaging modality, pharmacological adjuvant, and protocol for delayed repeat enema, and on the best approach for surgical management for intussusception in children.
OBJECTIVES
To assess the safety and effectiveness of non-surgical and surgical approaches in the management of intussusception in children.
SEARCH METHODS
We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library; Ovid MEDLINE (1950 to September 2016); Ovid Embase (1974 to September 2016); Science Citation Index Expanded (via Web of Science) (1900 to September 2016); and BIOSIS Previews (1969 to September 2016).We examined the reference lists of all eligible trials to identify additional studies. To locate unpublished studies, we contacted content experts, searched the World Health Organization International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (September 2016), and explored proceedings from meetings of the British Association of Paedatric Surgeons (BAPS), the American Soceity of Pediatric Surgery, and the World Congress of Pediatric Surgery.
SELECTION CRITERIA
We included all randomised controlled trials comparing contrast media, imaging modalities, pharmacological adjuvants, protocols for delayed repeat enema, and/or surgical approaches for the management of intussusception in children. We applied no language, publication date, or publication status restrictions.
DATA COLLECTION AND ANALYSIS
Two review authors independently conducted study selection and data extraction and assessed risk of bias using a standardised form. We resolved disagreements by consensus with a third review author when necessary. We reported dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs). We analysed data on an intention-to-treat basis and evaluated the overall quality of evidence supporting the outcomes by using GRADE criteria.
MAIN RESULTS
We included six randomised controlled trials (RCTs) with a total of 822 participants. Two trials compared liquid enema reduction plus glucagon versus liquid enema alone. One trial compared liquid enema plus dexamethasone versus liquid enema alone. Another trial compared air enema plus dexamethasone versus air enema alone, and two trials compared use of liquid enema versus air enema. We identified three ongoing trials.We judged all included trials to be at risk of bias owing to omissions in reported methods. We judged five of six trials as having high risk of bias in at least one domain. Therefore, the quality of the evidence (GRADE) for outcomes was low. Interventions and data presentation varied greatly across trials; therefore meta-analysis was not possible for most review outcomes. Enema plus glucagon versus enema alone It is uncertain whether use of glucagon improves the rate of successful reduction of intussusception when compared with enema alone (reported in two trials, 218 participants; RR 1.09, 95% CI 0.94 to 1.26;low quality of evidence). No trials in this comparison reported on the number of children with bowel perforation(s) nor on the number of children with recurrent intussusception. Enema plus dexamethasone versus enema alone Use of the adjunct, dexamethasone, may be beneficial in reducing intussusception recurrence with liquid or air enema (two trials, 299 participants; RR 0.14, 95% CI 0.03 to 0.60; low quality of evidence). This equates to a number needed to treat for an additional beneficial outcome of 13 (95% CI 8 to 37). It is uncertain whether use of the adjunct, dexamethasone, improves the rate of successful reduction of intussusception when compared with enema alone (reported in two trials, 356 participants; RR 1.01, 95% CI 0.92 to 1.10;low quality of evidence). Air enema versus liquid enema Air enema may be more successful than liquid enema for reducing intussusception (two trials, 199 participants; RR 1.28, 95% CI 1.10 to 1.49; low quality of evidence). This equates to a number needed to treat for an additional beneficial outcome of 6 (95% CI 4 to 19). No trials in this comparison reported on the number of children with bowel perforation(s) or on the number of children with recurrent intussusception nor any intraoperative complications, such as bowel perforation, or other adverse effects. Only one trial reported postoperative complications, but owing to the method of reporting used, a quantitative analysis was not possible. We identified no studies that exclusively evaluated surgical interventions for management of intussusception.
AUTHORS' CONCLUSIONS
This review identified a small number of trials that assessed a variety of interventions. All included trials provided evidence of low quality and were subject to serious concerns about imprecision, high risk of bias, or both. Air enema may be superior to liquid enema for successfully reducing intussusception in children; however, this finding is based on a few studies including small numbers of participants. Dexamethasone as an adjuvant may be more effective in reducing intussusception recurrence rates following air enema or liquid enema, but these results are also based on a few studies of small numbers of participants. This review highlights several points that need to be addressed in future studies, including reducing the risk of bias and including relevant outcomes. Specifically, surgical trials are lacking, and future research is needed to address this evidence gap.
Topics: Air; Child; Dexamethasone; Enema; Gastrointestinal Agents; Glucagon; Glucocorticoids; Humans; Intestinal Perforation; Intussusception; Postoperative Complications; Randomized Controlled Trials as Topic; Recurrence; Secondary Prevention
PubMed: 28567798
DOI: 10.1002/14651858.CD006476.pub3 -
Journal of Clinical and Experimental... May 2019Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO) are uncommon benign mixed odontogenic neoplasms. Although unusual microscopic changes including hybrid... (Review)
Review
BACKGROUND
Ameloblastic fibroma (AF) and ameloblastic fibro-odontoma (AFO) are uncommon benign mixed odontogenic neoplasms. Although unusual microscopic changes including hybrid tumors have been documented in publications, their clinical outcome prediction and treatment modality selection are still challenging due to scarcity. Objective: Analysis of AF/AFO's unusual microscopic variants in order to improve histopathologic diagnosis and to help clinicians in making informed treatment choices.
MATERIAL AND METHODS
An electronic search was performed in PubMed's database using keywords: "ameloblastic fibroma", "ameloblastic fibroodontoma", "ameloblastic fibro-odontoma". The search scheme was limited to articles in English, dated 'January 1998' to 'October 2018', with full texts (case reports and series) and human studies. Eligibility criteria included publications having enough clinical, radiological, and histological data to confirm their diagnosis. Age, sex, lesions' location, radiologic features, signs, symptoms, treatment approaches, and recurrences were recorded and analyzed.
RESULTS
In this systematic review, 11 articles (reporting 14 cases) were selected. Patients' mean age was 13.75 years (male/female = 1.8). The posterior region of the mandible was the lesions' commonest location (57.14%). Swelling was reported in 78.57% of the cases, pain in 28.57% but 21.42% were asymptomatic. Radiolucent unilocular appearance was the commonest radiographic feature, but 28.57% of the cases showed a mixed radiolucent-radiopaque appearance. Other reported radiographic findings were impacted tooth (78.57%), root resorption (28.57%), tooth mobility (35.71%), and cortical perforation (14.28%). No recurrences were reported. Calcifying odontogenic cyst (COC) was the commonest lesion associated with AF/AFO (53.33%). Unicystic ameloblastoma and cystic changes without prominent epithelial lining were other reported hybrid lesions. Reported microscopic variations were pigmentation and ghost cell differentiation.
CONCLUSIONS
COC was the commonest lesion associated with AF/AFO. Although COC commonly occurs in the jaws' anterior region, hybrid cases were more common in the posterior area. No malignant transformations were reported. The treatment modality is mostly chosen based on the lesion's most aggressive part. Ameloblastic fibroma, Ameloblastic fibro-odontoma, Odontogenic tumor, Jaw.
PubMed: 31275522
DOI: 10.4317/jced.55460 -
Danish Medical Journal Apr 2016Iatrogenic colon perforation is a feared complication to colonoscopy. Optimal management of the complication remains controversial. Traditionally, patients have been... (Review)
Review
INTRODUCTION
Iatrogenic colon perforation is a feared complication to colonoscopy. Optimal management of the complication remains controversial. Traditionally, patients have been referred to surgery. Now, with technological advances, endoscopic closure is increasingly performed as minimally invasive therapy. The aim of this systematic review was to assess the existing evidence in this field.
METHODS
Literature was searched on PubMed, Embase and the Cochrane databases. Papers found were reported according to the PRISMA guidelines. Trials on animals were excluded.
RESULTS
A total of 32 articles were assessed, including 19 case reports, one case control, three prospective studies and nine retrospective studies. The total number of patients who have undergone endoscopic closure (apart from case reports) and reported in the literature is 203 patients. Studies have reported a clinical success rate of 87.8% (standard deviation: ± 13.0%) on average and a median of 92.3% (range: 58.6-100%). The total number of patients needing surgery after attempted clip closure was 30 (14.7%); another four were found to have sealed perforations during surgery. One patient died after clip failure (0.5%). Articles presented a favourable, high outcome for endoscopic closure of iatrogenic colorectal perforations.
CONCLUSION
In a highly selective group of patients, endoscopic closure of iatrogenic colon perforations is recommended if the expertise is available.
Topics: Colon; Colonoscopy; Endoscopy, Digestive System; Humans; Intestinal Perforation; Rectum; Treatment Outcome
PubMed: 27034185
DOI: No ID Found -
Medicina Oral, Patologia Oral Y Cirugia... Nov 2015Analyze the most important prognostic factors when performing periapical surgery and compare the success rates of distinct authors. (Review)
Review
BACKGROUND
Analyze the most important prognostic factors when performing periapical surgery and compare the success rates of distinct authors.
INTRODUCTION
Periapical surgery is an approach to treat non-healing periapical lesions and it should be viewed as an extension of endodontic treatment and not as a separate entity.
MATERIAL AND METHODS
A search of articles published in Cochrane, PubMed (MEDLINE) and Scopus was conducted with the key words "prognostic factors", "prognosis", "periapical surgery", "endodontic surgery" and "surgical endodontic treatment". The inclusion criteria were articles including at least 10 patients, published in English, for the last 10 years. The exclusion criteria were nonhuman studies and case reports.
RESULTS
33 articles were selected from 321 initially found. Ten articles from 33 were excluded and finally the systematic review included 23 articles: 1 metaanalysis, 1 systematic review, 2 randomized clinical trials, 6 reviews, 12 prospective studies and 1 retrospective study. They were stratified according to their level of scientific evidence using the SORT criteria.
CONCLUSIONS
Factors associated with a better outcome of periapical surgery are patients ≤45 years old, upper anterior or premolar teeth, ≤10 sized lesions, non cystic lesions, absence of preoperative signs and symptoms, lesions without periodontal involvement, teeth with an adequate root-filling length, MTA as root-end filling material, uniradicular teeth, absence of perforating lesions, apical resection < 3 mm, teeth not associated to an oroantral fistula and teeth with only one periapical surgery.
Topics: Humans; Periapical Diseases; Prognosis; Root Canal Therapy
PubMed: 26449431
DOI: 10.4317/medoral.20613 -
JPRAS Open Jun 2024Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator... (Review)
Review
Despite the growing use of autologous breast reconstruction with medial thigh-based free flaps, such as transverse upper gracilis (TMG) or profunda artery perforator (PAP) flaps, these procedures are infrequently performed on patients with obesity. This systematic review and meta-analysis aimed to compare the frequency of seroma occurrence, a common complication after medial thigh flap surgery. Comparison was performed between TMG and PAP flaps, as well as medial thigh lifts (MTL), a procedure with a similar operative technique but which is typically offered to patients with a higher body mass index (BMI). Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we analyzed EMBASE, PUBMED, and MEDLINE data (English/German). The primary outcomes assessed were occurrence of seroma, as well as hematoma and wound dehiscence. Subgroup analyses explored age, BMI, and various surgical factors. This meta-analysis incorporated 28 studies, totaling 1096 patients. MTL patients had significantly higher BMIs, whereas seroma rates were similar among TMG, PAP, and MTL patients. The incidence of hematoma and wound dehiscence was also similar across the groups. In the metaregression analysis, factors such as age and BMI showed no significant correlation with seroma occurrence in all groups. This systematic review and meta-analysis identified comparable rates of seroma formation after TMG flap, PAP flap, and MTL procedures. Considering that this phenomenon occurred despite the elevated BMI of the MTL group, we propose that patients with higher BMI need not be excluded as candidates for autologous medial thigh-based breast reconstruction. Hence, these procedures should not be limited to small- to medium-sized breasts. Large-scale prospective studies are imperative to validate these conclusions and reveal the underlying factors contributing to seroma formation.
PubMed: 38770115
DOI: 10.1016/j.jpra.2024.03.013 -
Endoscopy International Open Nov 2016Palliative treatment of gastric outlet obstruction can be done with surgical or endoscopic techniques. This systematic review aims to compare surgery and covered and... (Review)
Review
Palliative treatment of gastric outlet obstruction can be done with surgical or endoscopic techniques. This systematic review aims to compare surgery and covered and uncovered stent treatments for gastric outlet obstruction (GOO). Randomized clinical trials were identified in MEDLINE, Embase, Cochrane, LILACs, BVS, SCOPUS and CINAHL databases. Comparison of covered and uncovered stents included: technical success, clinical success, complications, obstruction, migration, bleeding, perforation, stent fracture and reintervention. The outcomes used to compare surgery and stents were technical success, complications, and reintervention. Patency rate could not be included because of lack of uniformity of the extracted data. Eight studies were selected, 3 comparing surgery and stents and 5 comparing covered and uncovered stents.The meta-analysis of surgical and endoscopic stent treatment showed no difference in the technical success and overall number of complications. Stents had higher reintervention rates than surgery (RD: 0.26, 95 % CI [0.05, 0.47], NNH: 4). There is no significant difference in technical success, clinical success, complications, stent fractures, perforation, bleeding and the need for reintervention in the analyses of covered and uncovered stents. There is a higher migration rate in the covered stent therapy compared to uncovered self-expanding metallic stents (SEMS) in the palliation of malignant GOO (RD: 0.09, 95 % CI [0.04, 0.14], NNH: 11). Nevertheless, covered stents had lower obstruction rates (RD: - 0.21, 95 % CI [-0.27, - 0.15], NNT: 5). In the palliation of malignant GOO, covered SEMS had higher migration and lower obstruction rates when compared with uncovered stents. Surgery is associated with lower reintervention rates than stents.
PubMed: 27857965
DOI: 10.1055/s-0042-115935