Endoscopic Bariatric Therapies: Current Status and Future Perspectives.

Background: Obesity is a chronic, multifactorial disease associated with multiple cardiometabolic conditions. The successful management of this condition includes a multidisciplinary approach with interventions focused on lifestyle modification, pharmaceutical therapies, and bariatric surgery. Endoscopic bariatric therapies (EBT) have been proposed as a way to bridge the gap between medical management and bariatric surgery. The Association for Bariatric Endoscopy in conjunction with the American Society for Gastrointestinal Endoscopy published the position statement approving and integrating EBT into practice. The aim of this article is to review the most common primary EBT's, their indications, outcomes, and complications. Database: A medical literature review was conducted using the defined keywords. Databases included PubMed, Google Scholar, Embase, and EBSCO. Articles in English were considered for review from June 1, 2000 to June 30, 2021. Conclusion: Endoscopic bariatric therapies should be offered in conjunction with lifestyle modification and with nutritional guidance, as part of a multidisciplinary approach in obesity management. They require a formal training process for endoscopists and bariatric surgeons to obtain the endoscopic skills needed before performing these procedures. Longer follow-up and larger trials are needed to validate current evidence, in order to enhance the process of standardization of these techniques.

Ultrasound-guided fine needle aspiration cytology and ultrasound examination of thyroid nodules in the UAE: A comparison.

BACKGROUND: Thyroid nodules are a common clinical finding and most are benign, however, 5-15% can be malignant. There is limited regional data describing the accuracy of ultrasound-guided fine needle aspiration (FNA) cytological examination compared to ultrasound examination of thyroid in patients who have undergone thyroid surgery. METHODS: A retrospective analysis of ultrasonographic (US) reports, FNA cytology reports and histopathology reports of 161 thyroid nodules presented at the endocrine center at Tawam hospital in Al Ain city, the United Arab Emirates during the period 2011-2019 was performed. US reports and images with FNA cytopathology reports and slides were reviewed by an independent radiologist and pathologist. RESULTS: In total, 40 nodules were reported as benign by US examination, while very low suspicious, low suspicious, intermediate suspicious and highly suspicious categories were reported in 21, 41, 14 and 45 nodules respectively. In addition, 68 nodules were reported as benign (Bethesda category II), while atypical follicular cells of unknown significance (Bethesda category III), follicular neoplasm (Bethesda category IV), suspicious for malignancy (Bethesda category V), and malignant (Bethesda category VI) categories were reported in 33, 9, 24 and 27 nodules respectively. The risk of malignancy for US benign nodules was 5%, while the risks of malignancy in very low suspicious, low suspicious, intermediate suspicious and highly suspicious nodules were 52%, 36%, 100% and 87%, respectively. The risk of malignancy for Bethesda category II was 3%, while the risks of malignancy in category III, IV, V and VI were 58%, 67%, 96% and 100%, respectively. CONCLUSION: Thyroid FNA cytological examination and ultrasonography are key tools in predicting malignancy in thyroid nodules. Thyroid nodules with the diagnosis of Bethesda category III & IV run a high risk of malignancy thus more vigilance is required.

Outcomes and Impact of a Universal COVID-19 Screening Protocol for Asymptomatic Oncology Patients.

INTRODUCTION: COVID-19 has become a serious hazard worldwide in a relatively short time. Scientific evidence supports that cancer patients infected with COVID-19 had a higher risk of developing severe complications. COVID-19 patients can be asymptomatic during part or all of their disease course, therefore it is a compelling need to develop universal pre-interventional COVID-19 screening guidelines. The aim of this study is to is review COVID-19 positive rate among asymptomatic cancer patients since the implementation of universal policy at our institution, and assess the impact of diagnosing COVID-19 on delay of oncologic interventions. MATERIALS AND METHODS: The study population comprised of all cancer patients planned for high risk interventions between April 1, 2020 - May 14, 2020 at Cleveland Clinic Abu Dhabi [CCAD] after implementing universal COVID-19 screening policy. DISCUSSION: Nosocomial transmission of COVID-19 among cancer patients could result in poor outcomes. Universal screening for high-risk populations may facilitate earlier diagnosis of COVID-19 and implementation of control strategies. Our review demonstrated that [7.5%] of asymptomatic cancer patients tested positive for COVID-19 after implementation of universal prospective screening policy. The overall evidence supporting universal COVID-19 screening of cancer patients is limited, yet as tests become more widely available, it may be reasonable to screen all cancer patients for COVID-19 before anticancer therapies. While such policy may delay and affect the timing of anticancer therapy as shown in this report, it should improve the safety of care for oncology patients and help protect healthcare workers. CONCLUSION: COVID-19 infection rate is higher in cancer patients than general population and can present without symptoms. Universal COVID-19 screening of cancer patients before high risk interventions is supported by the present findings.