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ABSTRACT: Indeterminate biliary strictures pose a diagnostic challenge, and current approaches in the evaluation of such strictures lack diagnostic sensitivity. The most common method of tissue acquisition remains endoscopic retrograde cholangiopancreatography (ERCP) with brush cytology, however, little is known about optimal brush technique. In this paper by Wang et al., the authors compare the diagnostic sensitivity of brush cytology for 10, 20, and 30 passes in patients with malignant biliary strictures. The authors found an increase in sensitivity with an increasing number of passes, without an associated increase in adverse events. This well-designed study offers a simple and safe intervention which can increase the diagnostic sensitivity of ERCP-based brushing without requiring significant time, expense, or additional expertise.
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Constrição Patológica , HumanosRESUMO
INTRODUCTION: Gastrointestinal bleeding is a morbid complication of dual antiplatelet therapy (DAPT). We evaluated the extent to which contemporary trials of DAPT included steps to ensure appropriate use of proton pump inhibitor (PPI) gastroprotection and reported rates of PPI use. METHODS: A methodological review of randomized trials comparing varying durations of DAPT after percutaneous coronary intervention. RESULTS: Among 21 trials, none incorporated protocol procedures or guidance for prescribing PPIs. Five reported rates of PPI use (range 25.6-69.1%). DISCUSSION: PPI gastroprotection is overlooked in major trials of DAPT. Appropriate use of PPI gastroprotection represents an important opportunity to improve patient safety.
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Ensaios Clínicos como Assunto , Terapia Antiplaquetária Dupla/normas , Intervenção Coronária Percutânea/métodos , Inibidores da Agregação Plaquetária/uso terapêutico , Cuidados Pós-Operatórios/métodos , Guias de Prática Clínica como Assunto , Gastropatias/prevenção & controle , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Estômago/efeitos dos fármacosRESUMO
BACKGROUND: Coronavirus disease-2019 (COVID-19) is a global pandemic. Obesity has been associated with increased disease severity in COVID-19, and obesity is strongly associated with hepatic steatosis (HS). However, how HS alters the natural history of COVID-19 is not well characterized, especially in Western populations. AIMS: To characterize the impact of HS on disease severity and liver injury in COVID-19. METHODS: We examined the association between HS and disease severity in a single-center cohort study of hospitalized COVID-19 patients at Michigan Medicine. HS was defined by either hepatic steatosis index > 36 (for Asians) or > 39 (for non-Asians) or liver imaging demonstrating steatosis > 30 days before onset of COVID-19. The primary predictor was HS. The primary outcomes were severity of cardiopulmonary disease, transaminitis, jaundice, and portal hypertensive complications. RESULTS: In a cohort of 342 patients, metabolic disease was highly prevalent including nearly 90% overweight. HS was associated with increased transaminitis and need for intubation, dialysis, and vasopressors. There was no association between HS and jaundice or portal hypertensive complications. In a sensitivity analysis including only patients with liver imaging > 30 days before onset of COVID-19, imaging evidence of hepatic steatosis remained associated with disease severity and risk of transaminitis. CONCLUSIONS: HS was associated with increased disease severity and transaminitis in COVID-19. HS may be relevant in predicting risk of complications related to COVID-19.
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COVID-19/complicações , COVID-19/patologia , Fígado Gorduroso/complicações , Fígado Gorduroso/patologia , Fígado/patologia , SARS-CoV-2 , Estudos de Coortes , Humanos , Prevalência , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: To assess patient preferences for colorectal cancer screening with stool-based tests after initial colonoscopy with suboptimal bowel preparation. METHODS: An online scenario-based survey of adults aged 45 to 75 years at average risk for colorectal cancer was performed. RESULTS: When presented with a hypothetical scenario of screening colonoscopy with suboptimal bowel preparation, 59% of respondents chose stool-based testing as a next step, 29% preferred a repeat colonoscopy within a year, and 12% preferred a repeat colonoscopy in 10 years (N = 1,080). CONCLUSIONS: Clinicians should consider offering stool-based screening tests as an alternative to repeat colonoscopy after suboptimal bowel preparation.
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Colonoscopia/métodos , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/psicologia , Programas de Rastreamento/psicologia , Preferência do Paciente/estatística & dados numéricos , Idoso , Catárticos/administração & dosagem , Colonoscopia/psicologia , Estudos Transversais , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Sangue Oculto , Preferência do Paciente/psicologia , Fatores de TempoRESUMO
This paper highlights the potential importance of family history as an independent risk factor in those with a personal history of adenomas. It also raises important questions for future study about maternal versus paternal risk in CRC. However, we should be cautious about making changes to practice based on these data alone. In the future, such data could be used to generate individualized recommendations for post-polypectomy surveillance to ensure that we deliver the right care to the right patient at the right time.
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Adenoma , Pólipos do Colo , Neoplasias Colorretais , Colonoscopia , Humanos , Assistência ao Paciente , Fatores de Risco , Fatores de TempoAssuntos
Edema/diagnóstico por imagem , Doenças dos Genitais Masculinos/diagnóstico por imagem , Transplante de Pâncreas/efeitos adversos , Pancreatite/complicações , Escroto/diagnóstico por imagem , Aloenxertos/patologia , Diabetes Mellitus Tipo 1/cirurgia , Drenagem , Edema/etiologia , Doenças dos Genitais Masculinos/etiologia , Doenças dos Genitais Masculinos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Pancreatite/patologia , Escroto/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Artrite/etiologia , Diarreia/etiologia , Duodeno/patologia , Tropheryma/isolamento & purificação , Doença de Whipple/diagnóstico , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Endoscopia do Sistema Digestório , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Redução de Peso , Doença de Whipple/complicações , Doença de Whipple/tratamento farmacológicoRESUMO
Video 1Full metal jacket: salvage of EUS-guided gallbladder drainage.
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Video 1Single-session EUS-guided gastrogastrostomy creation to facilitate cystgastrostomy in Roux-en-Y gastric bypass.
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Video 1Closure of blind limb after gastric bypass as a treatment for candy cane limb syndrome.
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Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a safe and efficacious procedure to treat pancreaticobiliary diseases in Roux-en-Y gastric bypass (RYGB). This multicenter study aimed to determine the long-term outcomes of EDGE focusing on fistula persistence rates and post-procedure weight change. Patients and methods Information about patients with Roux-en-Y gastric bypass anatomy who underwent EDGE between 2015 and 2021 from 10 institutions was captured in a registry. Patient demographics, procedural details, and clinical outcomes were analyzed. Results One hundred seventy-two patients were included in the study (mean age 60, 25â% male). Technical success of lumen-apposing metal stent (LAMS) placement was 171 of 172 (99.4â%) while clinical success of intervention was 95%. The mean procedure time was 65 minutes. The most commonly reported complication was stent dislodgement/migration (nâ=â29, 17). Mean length of time of LAMS duration was 69 days. Mean follow-up time was 6 months. Endoscopic fistula closure was performed in 40â% of patients (69/172) at the time of LAMS removal. Persistence of fistula was observed in 19 of 62 patients (31â%) assessed. Length of LAMS indwell time (days) was a predictor of persistent fistula. The average weight gain while the LAMS was in place was 12 lb in 63 patients (36.6â%); 59.4â% of patients gainedâ<â5 lb. Conclusions EDGE is a safe and efficacious procedure for RYGB patients requiring ERCP. Post-procedure evaluation and management of the enteral fistula varies widely among centers currently and would benefit from further standardization. Fistula persistence appears to be uncommon and can be managed endoscopically but may be related to length of indwell times of the LAMS.
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Video 1Endoscopic impedance planimetry system measurement and pneumatic balloon dilation of a sleeve gastrectomy stricture.
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Video 1.If at first you don't succeed A complicated course of endoscopic reversal of a gastric bypass.
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BACKGROUND: Gastric sleeve stenosis (GSS) occurs in up to 4% of patients after laparoscopic sleeve gastrectomy (LSG). Typical symptoms include reflux, abdominal pain, dysphagia, and regurgitation. Serial pneumatic balloon dilation (PBD) is a successful treatment in many cases obviating the need for revisional surgery, but the potential for weight regain is unknown. The aim of the current study was to assess weight trends following serial pneumatic dilation for GSS. METHODS: Retrospective analysis of a prospectively maintained database of patients undergoing serial PBD for GSS at one institution. Primary outcome was change in BMI before and after serial PBD. Secondary outcomes included complication rates and need for revisional surgery. Sub-group analyses were performed to determine the relationship of patient and procedural factors to BMI after PBD. RESULTS: Forty-four patients met inclusion criteria, 34 (84.1%) women. Mean age was 46.7 (SD 11.9). Mean pre-sleeve BMI was 47.8 (SD 9.2), and mean BMI prior to first dilation was 34.2 (SD 6.8). Median follow-up was 395 days (range 48-571). Mean BMI at time of last follow up was 33.7 (SD 6.7). There was no statistical difference in BMI pre- or post-PBD (p 0.980). The lowest 10th and highest 90th BMI percentile trended toward a higher and lower BMI after PBD, respectively, though not significant. DISCUSSION: As the prevalence of sleeve gastrectomy continues to rise, an increasing number of patients will require treatment for GSS. Stenosis is effectively treated with serial PBD in most patients without any impact on weight gain, making this an effective and appealing option for many patients.
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Laparoscopia , Obesidade Mórbida , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Dilatação/efeitos adversos , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Aumento de PesoRESUMO
Video 1Video demonstration of endoscopic sleeve gastroplasty performed using a novel suture pattern termed the "cable" technique.
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Video 1A unique twist following treatment of a sleeve gastrectomy leak: a multidisciplinary approach.