Endoscopic submucosal dissection (ESD): how do Western endoscopists value animal models?

INTRODUCTION: Endoscopic Submucosal Dissection (ESD)was introduced in the West later than in the East. Our aim was to assess how Western endoscopists performing ESD have been trained and how they value animal models for training. MATERIAL AND METHODS: An online survey regarding training in ESD was sent to Western endoscopists who published articles on advanced resection techniques. RESULTS: From 279 endoscopists, 58 (21%) completed the questionnaire, of which 50 confirmed performance of clinical ESD. Endoscopists had a median of 15 years of endoscopic experience (IQR 9.75-20.25) and all of them were performing conventional EMR, before starting ESD. Prior to clinical ESD, 74% (n = 37) underwent training with ex vivo models, 84% (n = 42) with live animal models and 92% (n = 46) with at least, one of the two models. After starting clinical ESD, as trainers, 52% (n = 26) were involved with ex vivo and 60% (n = 30) with live animal models. Personal usefulness of ex vivo and live animal models was rated with a median of 9 (IQR 8-10) and 10 (IQR 8-10), out of 10, respectively. Courses with ex vivo and live animal models were considered a prerequisite before clinical practice by 84% (n = 42) and 78% (n = 39), respectively. CONCLUSIONS: Western endoscopists have extensive endoscopic experience before starting ESD. The majority had pre-clinical training with ex vivo and live animal models and more than half are acting as trainers of other endoscopists with these models. Animal models are considered very useful and deemed a prerequisite before clinical practice by the majority of the endoscopists.

How Is Endoscopic Submucosal Dissection for Gastrointestinal Lesions Being Implemented? Results from an International Survey.

BACKGROUND AND STUDY AIM: Superficial gastrointestinal (GI) neoplasms can be treated with endoscopic mucosal resection (EMR) and/or endoscopic submucosal dissection (ESD). These techniques are widely used in Eastern countries; however, its use in the West is limited. The aim of this study was to evaluate the current implementation of ESD in Western countries. METHODS: Western endoscopists (n = 279) who published papers related to EMR/ESD between 2005 and 2017 were asked to complete an online survey from December 2017 to February 2018. RESULTS: A total of 58 endoscopists (21%) completed the survey. Thirty performed ESD in the esophagus (52%), 45 in the stomach (78%), 36 in the co-lorectum (62%), and 6 in the duodenum (10%). The median total number of lesions ever treated per endoscopist was 190, with a median number per endoscopist in 2016 of 41 (7 [IQR 1-21], 6 [IQR 4-16], and 28 [5-63] in the esophagus, in the stomach, and in the colon and rectum, respectively). En bloc resection rates were 97% in the esophagus, 95% in the stomach, and 84% in the colorectum. Complete resection (R0) was achieved in 88, 91, and 81%, respectively. Curative rates were 69, 70, and 67%, respectively. Major complications (perforation or delayed bleeding) occurred more often in colorectal ESD (12 vs. 6% in the esophagus and 7% in the stomach). In the upper GI tract, the majority of resected lesions were intramucosal adenocarcinoma (59% in the esophagus; 47% in the stomach), while in the colorectum the majority were adenomas (59%). CONCLUSION: ESD seems to be performed by a large number of centers and endoscopists. Our results suggest that ESD is being successfully implemented in Western countries, achieving a good rate of efficacy and safety according to European guidelines.

INTRODUÇÃO E OBJETIVOS: As lesões superficiais gastrointestinais podem ser tratadas por musectomia (EMR) e/ou disseção endoscópica da submucosa (ESD). Estas técnicas são usadas frequentemente nos países asiáticos, mas a experiência é mais limitada nos países ocidentais. O objetivo deste estudo foi avaliar a implementação atual da ESD nos países ocidentais. MÉTODOS: Gastroenterologistas ocidentais (n = 279) com artigos publicados entre 2005 e 2017 relacionados com EMR/ESD foram solicitados a preencher um questionário online, no período de Dezembro 2017 até Fevereiro 2018. RESULTADOS: Um total de 58 gastroenterologistas (21%) completou o inquérito. Trinta realizaram ESD esofágica (52%); 45 gástrica (78%); 36 coloretal (62%); e 6 duodenal (10%). A mediana do número total de lesões ressecadas por endoscopista foi 190, sendo que, em 2016, a mediana de lesões tratadas por cada gastroenterologista foi 41 (7 [IQR 1­21] no esófago, 6 [IQR 4­16] no estómago e 28 [5­63] no côlon e reto). A taxa de ressecção em bloco foi de 97% nas lesões esofágicas; 95% nas lesões gástricas e 84% nas lesões coloretais, com uma proporção de casos RO de 88, 91 e 81%, respetivamente. A taxa de casos curados foi de 69, 70 e 67%, respetivamente. A taxa de complicações graves (perfuração e hemorragia tardia) foi maior na ESD coloretal (12% dos casos vs. 6% no esófago e 7% no estômago). A maioria das lesões esofagogástricas eram adenocarcinomas intramucosos (59% no esófago; 47% no estômago), enquanto as lesões coloretais eram maioritariamente adenomas (59%). CONCLUSÕES: Este estudo mostra uma disseminação da ESD na europa por um maior número de centros e gas-trenterologistas. Os nossos resultados sugerem uma utilização e eficácia global de acordo corn as recomendações europeias.

Association between nonalcoholic fatty liver disease and cardiac function and structure-a meta-analysis.

PURPOSE: Nonalcoholic fatty liver disease is increasingly recognized as the hepatic counterpart of metabolic syndrome. It is hypothesized that structural and functional cardiac changes may be associated with this metabolic disease. We aimed to gather the existing information on the association of nonalcoholic fatty liver disease with cardiac alterations, and to evaluate a possible correlation between them. METHODS: Systematic review of Medline searching results for original articles studying NAFLD and cardiac parameters until August 2018. A meta-analysis was conducted to each parameter of cardiac structure and function selected, using Review Manager 5.3 software. This study was conducted according to preferred reporting items for systematic reviews and meta-analysis (PRISMA). RESULTS: A total of 16 studies met the eligibility criteria and were included in the meta-analysis. There was a significant association between nonalcoholic fatty liver disease and (1) higher left ventricle mass and ratios between left ventricle mass and both height and body surface area; (2) higher LVEDD; (3) higher left atrium diameter and ratio between left atrial volume and body surface area; (4) higher posterior wall and septum thickness; (5) lower E/A wave ratio; (6) higher E/E' ratio; (7) longer deceleration time and (8) longer relaxation time. CONCLUSION: NAFLD associates with adverse structural alterations and cardiac dysfunction. Our results highlight the importance of identifying NAFLD in patients with metabolic dysfunction as this may represent an additional contributor to cardiovascular risk.