Safety and efficacy of a novel resection system for direct endoscopic necrosectomy of walled-off pancreas necrosis: a prospective, international, multicenter trial.

BACKGROUND AND AIMS: Direct endoscopic necrosectomy (DEN) of walled-off pancreatic necrosis (WOPN) lacks dedicated instruments and requires repetitive and cumbersome procedures. This study evaluated the safety and efficacy of a new powered endoscopic debridement (PED) system designed to simultaneously resect and remove solid debris within WOPN. METHODS: This was a single-arm, prospective, multicenter, international device trial conducted from November 2018 to August 2019 at 10 sites. Patients with WOPN ≥6 cm and ≤22 cm and with >30% solid debris were enrolled. The primary endpoint was safety through 21 days after the last DEN procedure. Efficacy outcomes included clearance of necrosis, procedural time, adequacy of debridement, number of procedures until resolution, hospital stay duration, and quality of life. RESULTS: Thirty patients (mean age, 55 years; 60% men) underwent DEN with no device-related adverse events. Of 30 patients, 15 (50%) achieved complete debridement in 1 session and 20 (67%) achieved complete debridement within 2 or fewer sessions. A median of 1.5 interventions (range, 1-7) were required. Median hospital stay was 10 days (interquartile range, 22). There was an overall reduction of 91% in percent necrosis within WOPN from baseline to follow-up and 85% in collection volume. Baseline WOPN volume was positively correlated with the total number of interventions (ρ = .363, P = .049). CONCLUSIONS: The new PED system seems to be a safe and effective treatment tool for WOPN, resulting in fewer interventions and lower hospital duration when compared with published data on using conventional instruments. Randomized controlled trials comparing the PED system with conventional DEN are needed. (Clinical trial registration number: NCT03694210.).

Confidentiality and Conflicts of Interest: An Assessment of Twitter Posts in Gastrointestinal Endoscopy.

INTRODUCTION: To evaluate compliance with confidentiality and conflicts of interest (COI) in tweets sharing gastrointestinal (GI) endoscopy videos/images. METHODS: Physicians' tweets containing GI endoscopy videos/images were assessed for confidentiality and COI compliance. RESULTS: Identifiable details in tweets included procedure date (17.9%), date of birth (0.8%), and patient's face visible (0.5%). Ninety-five tweets (10%) mentioned the name/brand of a medical device. Of the 19 posted by US physicians, 7 came from physicians who had received payments from the device manufacturer. None of these physicians disclosed relevant COI. DISCUSSION: GI endoscopy tweets describing clinical cases or procedures may insufficiently address issues of confidentiality and COI.

Endoscopic ultrasound-directed transgastric ERCP (EDGE): a retrospective multicenter study.

BACKGROUND: Endoscopic ultrasound-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) is an alternative to enteroscopy- and laparoscopy-assisted ERCP in patients with Roux-en-Y gastric bypass anatomy. Although short-term results are promising, the long-term outcomes are not known. The aims of this study were: (1) to determine the rates of long-term adverse events after EDGE, with a focus on rates of persistent gastrogastric or jejunogastric fistula; (2) to identify predictors of persistent fistula; (3) to assess the outcomes of endoscopic closure when persistent fistula is encountered. METHODS: This was a multicenter retrospective study involving 13 centers between February 2015 and March 2019. Adverse events were defined according to the ASGE lexicon. Persistent fistula was defined as an upper gastrointestinal series or esophagogastroduodenoscopy showing evidence of fistula. RESULTS: 178 patients (mean age 58 years, 79 % women) underwent EDGE. Technical success was achieved in 98 % of cases (175/178), with a mean procedure time of 92 minutes. Periprocedural adverse events occurred in 28 patients (15.7 %; mild 10.1 %, moderate 3.4 %, severe 2.2 %). The four severe adverse events were managed laparoscopically. Persistent fistula was diagnosed in 10 % of those sent for objective testing (9/90). Following identification of a fistula, 5 /9 patients underwent endoscopic closure procedures, which were successful in all cases. CONCLUSIONS: The EDGE procedure is associated with high clinical success rates and an acceptable risk profile. Persistent fistulas after lumen-apposing stent removal are uncommon, but objective testing is recommended to identify their presence. When persistent fistulas are identified, endoscopic treatment is warranted, and should be successful in closing the fistula.

Longitudinal relationship between social media activity and article citations in the journal Gastrointestinal Endoscopy.

BACKGROUND AND AIMS: Social media activity in the area of scientific journal publications has increased significantly over the last decade. Several studies have suggested that journal article citations can be positively impacted by an increase in social media activity. Preliminary data have also suggested that published articles in the field of gastroenterology and hepatology that were discussed on Twitter were independently associated with higher citation rates compared with those that were not. Gastrointestinal Endoscopy (GIE) is the most widely cited endoscopy-focused journal in the world. We aimed to assess the association of social media exposure of published articles in GIE and its impact on article citations. METHODS: Data regarding journal article publication status, number of citations per article, and social media exposure per article using Altmetric data were collected from the publisher. All original articles published in GIE from 2000 to 2016 were reviewed. Editorials, case reports, and other nonresearch correspondence were excluded. Multivariable linear regression was used to assess for independent Altmetric predictors of higher citation rates over time. Logistic regression was used to assess the impact of an article mention on various social media platforms and whether it was cited during the study period. RESULTS: A total of 2361 original research articles were evaluated; 2050 articles (86.8%) were cited at least once during the follow-up period. Mean number of citations per article was 16.8 ± 23. The average Altmetric Attention score was 2.0 ± 13. The most profound independent predictor of article citation was whether an article was tweeted (odds ratio [OR], 14.2; 95% confidence interval [CI], 8.93-22.45). Other predictors were Facebook posts (OR, 1.08; 95% CI, 1.03-1.51) and number of Mendeley readers (OR, 1.359; 95% CI, 1.28-1.45). On multivariable linear regression, number of tweeters (ß = 2.3, P = .022), F1000 reviews (ß = 5.87, P < .001), policy documents (ß = 7.6, P < .001), and number of Mendeley readers (ß = 14.21, P < .001) were significantly associated with higher citation rates of published articles. CONCLUSIONS: For original articles published in GIE, there was a strong association between social media exposure on Twitter and rates of journal article citations. To a lesser degree, Facebook posts and Mendeley readers also were associated with a higher rate of article citations. This could represent both cause and effect and may be representative of higher quality articles being more commonly mentioned on social media by third-party users. A randomized controlled study evaluating different degrees of social media exposure on individual articles could be considered to further assess for causality.

Endoscopic treatment of obesity.

PURPOSE OF REVIEW: Obesity and its comorbid illnesses affect millions worldwide and are one of the major causes of preventable death in the world. Bariatric surgery is currently offered to individuals with a BMI greater than 40 kg/m or greater than 35 kg/m with obesity-related comorbidities such as hypertension or diabetes. Endoscopic bariatric therapies, with their reduced invasiveness and potential reversibility, may complement surgical approaches for achieving weight loss. RECENT FINDINGS: At the time of this writing, two endoscopically placed intragastric balloons and an endoscopically placed aspiration tube have been approved by the Food and Drug Administration for weight loss purposes. Some devices employ a suturing platform to create plications or to appose two surfaces. Other endoscopic strategies under investigation to treat obesity-related comorbidities such as diabetes include duodenal mucosal resurfacing and creation of a partial jejunoileal diversion using self-assembling magnets. SUMMARY: Current endoscopic methods for the treatment of obesity utilize various mechanisms, including occupying gastric volume, reducing gastric capacity, altering caloric absorption, or aspirating gastric contents. The long-term outcomes and cost-effectiveness of these strategies remain to be fully elucidated. The landscape of endoscopic bariatric therapies continues to evolve.

Navigating and Leveraging Social Media.

Social media has made a noteworthy impact in health care both in public health efforts as well as transforming how physicians connect and exchange ideas. Learning how to navigate and leverage social media across multiple platforms is becoming increasingly difficult with more platforms and features constantly being introduced. Different physicians working in the same field will have different purposes behind getting on social media, but each physician plays a different role within this social media ecosystem. This article aims to identify the common benefits of health care social media use as well as navigate the unfortunate pitfalls of social media use.

Fake News: Spread of Misinformation about Urological Conditions on Social Media.

Although there is a large amount of user-generated content about urological health issues on social media, much of this content has not been vetted for information accuracy. In this article, we review the literature on the quality and balance of information on urological health conditions on social networks. Across a wide range of benign and malignant urological conditions, studies show a substantial amount of commercial, biased and/or inaccurate information present on popular social networking sites. The healthcare community should take proactive steps to improve the quality of medical information on social networks. PATIENT SUMMARY: In this review, we examined the spread of misinformation about urological health conditions on social media. We found that a significant amount of the circulating information is commercial, biased or misinformative.

Clinical approach to incidental pancreatic cysts.

The approach to incidentally noted pancreatic cysts is constantly evolving. While surgical resection is indicated for malignant or higher risk cysts, correctly identifying these highest risk pancreatic cystic lesions remains difficult. Using parameters including cyst size, presence of solid components, and pancreatic duct involvement, the 2012 International Association of Pancreatology (IAP) and the 2015 American Gastroenterological Association (AGA) guidelines have sought to identify the higher risk patients who would benefit from further evaluation using endoscopic ultrasound (EUS). Not only can EUS help further assess the presence of solid component and nodules, but also fine needle aspiration of cyst fluid aids in diagnosis by obtaining cellular, molecular, and genetic data. The impact of new endoscopic innovations with novel methods of direct visualization including confocal endomicroscopy require further validation. This review also highlights the differences between the 2012 IAP and 2015 AGA guidelines, which include the thresholds for sending patients for EUS and surgery and methods, interval, and duration of surveillance for unresected cysts.