Long-term outcomes of endoscopic papillary large-balloon dilation (12-15 mm) with or without limited sphincterotomy for removal of bile duct stones.

BACKGROUND: Limited endoscopic sphincterotomy with large balloon dilation (ES-LBD) and endoscopic papillary large-balloon dilation (EPLBD) have been proven safe and effective for removal of bile duct stones. However, the long-term outcomes are not clear. The aim of this study was to assess the long-term outcomes of EPLBD (12-15 mm) with or without limited sphincterotomy for removal of common bile duct (CBD) stones. METHODS: Patients with EPLBD or ES-LBD referred for the removal of bile-duct stones between June 2008 and August 2020 were retrospectively reviewed. Complete stone clearance, endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events, and late biliary complications during long-term follow-up were analyzed. RESULTS: Basic patient characteristics were not significantly different between the groups that underwent EPLBD (n = 168) and ES-LBD (n = 57). EPLBD compared with ES-LBD resulted in similar outcomes in terms of overall successful stone removal (99.4% vs. 100%, P = 1.00) and ERCP-related adverse events (7.7% vs. 5.3%, P = 0.77). The mean duration of the follow-up were 113.6 months and 106.7 months for patients with EPLBD and ES-LBD, respectively (P = 0.13). There was no significant difference between EPLBD and ES-LBD in the incidence of stone recurrence [20 (11.9%) vs. 9 (15.8%); P = 0.49]. Multivariate analysis showed that a diameter of CBD ≥ 15 mm (OR = 3.001; 95% CI: 1.357-6.640; P = 0.007) was an independent risk factor for stone recurrence. CONCLUSIONS: The application of a large balloon (12-15 mm) via EPLBD is an effective and safe alternative to ES-LBD for extraction of large CBD stones. Endoscopic sphincterotomy prior to EPLBD may be unnecessary. A diameter of CBD ≥ 15 mm is a risk factor of stone recurrence.

A meta-analysis of efficacy of topical steroids in eosinophilic esophagitis: From the perspective of histologic, clinical, and endoscopic outcome / Un metaanálisis de eficacia de los esteroides tópicos en la esofagitis eosinofílica desde la perspectiva del resultado histológico, clínico y endoscópico

Background: Swallowed topical steroids are a mainstay drug therapy for eosinophilic esophagitis (EoE), studies have demonstrated good histologic response, but with enormous discrepancy in clinical and endoscopic improvement. We conducted this meta-analysis to investigate the efficacy of topical steroids in EoE in histological, clinical and endoscopic improvement. Methods: Several databases were searched from inception to August 1, 2019 for randomized controlled trials (RCTs) comparing topical steroids with placebo for EoE in the short-term. The outcomes of interest mainly included basic characteristics of the studies, histologic, clinical, endoscopic response rate and adverse events. The results were pooled together using Reviewer Manager 5.3.5 software, and inconsistency was quantified using I2 statistics. Results: Nine studies were eventually selected. The results showed that topical steroids were effective in inducing histologic response compared with placebo for both complete (OR 35.82, 95% CI 14.98–85.64, P<0.0001; I2=0, P=0.72) and partial response (OR 28.44, 95% CI 8.56–94.47, P<0.0001; I2=70%, P=0.0009). Moreover, topical steroids were useful in gaining clinical response (OR 2.53, 95% CI 1.14–5.60, P=0.02; I2=60%, P=0.02) and endoscopic response (OR 3.51, 95% CI 1.47–8.36, P=0.005; I2=0, P=0.57). Generally, topical steroids are well tolerated. The most common adverse events are infections and infestations (59 cases). Conclusion: Topical steroids were effective in inducing histological, clinical and endoscopic response in the short-term, and the adverse events were almost tolerable; however, we should interpret the result of clinical and endoscopic response with caution.(AU)

Antecedentes: Los esteroides tópicos tragados son una terapia farmacológica principal de la esofagitis eosinofílica (EoE). Algunos estudios han demostrado una buena respuesta histológica, aunque con gran discrepancia en la mejora clínica y endoscópica. Hemos realizado este metaanálisis para investigar la eficacia de los esteroides tópicos en EoE en la mejora histológica, clínica y endoscópica. Métodos: Se buscaron varias bases de datos desde el inicio hasta el 1 de agosto de 2019 para ensayos controlados aleatorios comparando esteroides tópicos con placebo para EoE a corto plazo. Los resultados de interés incluyeron principalmente características básicas de los estudios, histológicas, clínicas, tasa de respuesta endoscópica y eventos adversos. Los resultados se agruparon mediante el software de Reviewer Manager 5.3.5, y la incoherencia se cuantificó mediante estadísticas I2. Resultados: Nueve estudios fueron finalmente seleccionados. Los resultados mostraron que los esteroides tópicos fueron eficaces en la inducción de la respuesta histológica en comparación con placebo tanto para la respuesta completa (OR 35,82; IC 95%: 14,98-85,64; p<0,0001; I2 0, p=0,72) como para la parcial (OR 28,44; IC 95%: 8,56-94,47; p<0,0001; I2 70%, p=0,0009). Los esteroides tópicos también fueron útiles en la obtención de respuesta clínica (OR 2,53; IC 95%: 1,14-5,60; p=0,02; I2 60%; p=0,02) y respuesta endoscópica (OR 3,51; IC 95%: 1,47-8,36; p=0,005; I2 0; p=0,57). Los esteroides tópicos suelen ser bien tolerados. Los acontecimientos adversos más frecuentes son infecciones e infestaciones (59 casos). Conclusión: Los esteroides tópicos fueron eficaces en la inducción de la respuesta histológica, clínica y endoscópica a corto plazo, y los eventos adversos fueron tolerables; sin embargo, debemos interpretar con precaución el resultado de la respuesta clínica y endoscópica.(AU)

A meta-analysis of efficacy of topical steroids in eosinophilic esophagitis: From the perspective of histologic, clinical, and endoscopic outcome.

BACKGROUND: Swallowed topical steroids are a mainstay drug therapy for eosinophilic esophagitis (EoE), studies have demonstrated good histologic response, but with enormous discrepancy in clinical and endoscopic improvement. We conducted this meta-analysis to investigate the efficacy of topical steroids in EoE in histological, clinical and endoscopic improvement. METHODS: Several databases were searched from inception to August 1, 2019 for randomized controlled trials (RCTs) comparing topical steroids with placebo for EoE in the short-term. The outcomes of interest mainly included basic characteristics of the studies, histologic, clinical, endoscopic response rate and adverse events. The results were pooled together using Reviewer Manager 5.3.5 software, and inconsistency was quantified using I2 statistics. RESULTS: Nine studies were eventually selected. The results showed that topical steroids were effective in inducing histologic response compared with placebo for both complete (OR 35.82, 95% CI 14.98-85.64, P<0.0001; I2=0, P=0.72) and partial response (OR 28.44, 95% CI 8.56-94.47, P<0.0001; I2=70%, P=0.0009). Moreover, topical steroids were useful in gaining clinical response (OR 2.53, 95% CI 1.14-5.60, P=0.02; I2=60%, P=0.02) and endoscopic response (OR 3.51, 95% CI 1.47-8.36, P=0.005; I2=0, P=0.57). Generally, topical steroids are well tolerated. The most common adverse events are infections and infestations (59 cases). CONCLUSION: Topical steroids were effective in inducing histological, clinical and endoscopic response in the short-term, and the adverse events were almost tolerable; however, we should interpret the result of clinical and endoscopic response with caution.

Prevalence of musculoskeletal symptoms among industrial employees in a modern industrial region in Beijing, China.

BACKGROUND: Growing industrialization of China exposes its labor population to the risk of musculoskeletal disorders (MSDs). This study aimed to investigate the prevalence and risk factors of MSDs in a modern industrial region of Beijing. METHODS: A cross-sectional study included 1415 employees in six industrial companies was conducted between January 2018 and May 2018 in Fangshan district, Beijng, China. Nordic Musculoskeletal Questionnaire (NMQ) was used to collect the information about MSDs. Demographic factors, lifestyle factors, health and medical factors, and work-related factors were collected as independent variables. Descriptive statistics, the chi-squared (χ) test, and binary logistic regression analysis were used to analyze data. RESULTS: Among 1415 participants, 498 reported MSDs. The regions involved were the neck (25.16%), shoulders (17.17%), and upper back (13.29%). There was a significant statistical difference between frontline industrial workers and other staff in the prevalence of self-reported symptoms involving the shoulders (χ = 4.33, P = 0.037), wrists and hands (χ = 8.90, P = 0.003), and ankles and feet (χ = 12.88, P < 0.001). Increased age (P = 0.005, OR = 1.63; P = 0.001, OR = 2.33), a high or a low salary (P < 0.001, OR = 0.49; P < 0.001, OR = 0.30), night-shift (P = 0.027, OR = 1.46), two-week-history of illness and treatment (P = 0.004, OR = 5.60; P = 0.013, OR = 4.19), concurrent chronic diseases (P = 0.001, OR = 3.45; P = 0.092, OR = 7.81), limited access to health information (P = 0.004, OR = 0.49), and negative attitude towards seeking healthcare (P = 0.010, OR = 1.77; P = 0.009, OR = 2.75) were associated with MSDs in frontline workers. Female gender (P < 0.001, OR = 2.30), high education (P = 0.001, OR = 1.96), no exercises (P = 0.027, OR = 0.59), night-shift (P = 0.017, OR = 1.98), concurrent chronic diseases (P = 0.002, OR = 3.73; P = 0.020, OR = 13.42), limited access to health information (P = 0.013, OR = 0.53), far distance to medical institution (P = 0.009, OR = 1.83), and negative propensity (P = 0.009, OR = 1.94; P = 0.014, OR = 2.74) were associated with MSDs in other staffs. CONCLUSIONS: The prevalence of MSDs among industrial employees has changed. Frontline workers had different prevalence and risk factors for MSDs compared with other employees. Negative propensity to healthcare, limited ways to obtain health knowledge, and concomitant chronic diseases were associated with MSDs. Surprisingly, highly educated and high-income employees had a higher risk of MSDs.

Overexpression of eukaryotic initiation factor 5A2 (EIF5A2) is associated with cancer progression and poor prognosis in patients with early-stage cervical cancer.

AIMS: As one of the only two isoforms of the eukaryotic initiation factor (EIF)5A family, EIF5A2 plays an important role in tumour progression and prognosis evaluation. The aim of this study was to investigate EIF5A2 expression in International Federation of Gynecology and Obstetrics (FIGO) stage I-II cervical cancer and to evaluate its clinical significance. METHODS AND RESULTS: The mRNA and protein expression levels of EIF5A2 were analysed in 20 tissue samples of FIGO stage I-II cervical cancer and paired surrounding non-tumour cervical tissues by real-time polymerase chain reaction and western blot analysis. Immunohistochemistry was performed to examine EIF5A2 protein expression in paraffin-embedded tissues from 314 patients with cervical cancer. The mRNA and protein expression levels of EIF5A2 were significantly elevated in tumour tissues. The increased EIF5A2 expression was correlated with higher FIGO stage (P < 0.001), deep cervical stromal invasion (P = 0.026), lymphovascular space involvement (P = 0.002), pelvic lymph node metastasis (P < 0.001) and postoperative recurrence (P < 0.001) in patients with cervical cancer. Patients with tumours showing high EIF5A2 expression had a poorer survival time than those with normal EIF5A2 expression, especially the patients with negative pelvic lymph nodes and FIGO stage II. In addition, multivariate Cox analysis showed that high EIF5A2 expression was an independent prognostic factor for overall survival [hazard ratio 1.949; 95% confidence interval (CI) 1.116-3.404; P = 0.019] and disease-free survival (hazard ratio 1.980; 95% CI 1.189-3.297; P = 0.009). CONCLUSIONS: EIF5A2 overexpression may contribute to cancer progression and poor prognosis. Therefore, EIF5A2 could be a novel potential prognostic marker for FIGO stage I-II cervical cancer.

Systematic review and meta-analysis of patient-controlled sedation versus intravenous sedation for colonoscopy.

BACKGROUND: Patient-controlled sedation (PCS) has been suggested as an alternative method for sedative colonoscopy. However, as any new techniques, PCS introduction as a potential alternative to traditional intravenous sedation (IVS) has brought about challenges. To evaluate the advantages and disadvantages between PCS and IVS more comprehensively, we conducted a systematic review and meta-analysis of the published literature. METHODS: Several databases were searched from inception to 1 April, 2015, for trials comparing PCS with IVS for colonoscopy. The outcomes of interest included time for cecal intubation, rate of complete colonoscopy, dose of sedative drugs used, pain scores, recovery time, complications. Inconsistency was quantified using I (2) statistics. RESULTS: In all, 12 trials were finally selected (1091 patients, with 545 in the PCS group, and 546 in the IVS group). The total propofol used, time for cecal intubation, rate of complete colonoscopy and pain score had no statistical difference between the two groups. However, PCS showed a reduction in the recovery time, incidence of oxygen desaturation and hypotension. The rates of other complications and patients' willingness to repeat the same sedation had no statistical difference between the two groups. CONCLUSION: PCS is as feasible and effective as traditional IVS for colonoscopy, and there is a tendency that PCS shows its superiority in recovery time, incidence for oxygen saturation and hypotension.

Usefulness of an algorithm for endoscopic retrieval of proximally migrated 5Fr and 7Fr pancreatic stents.

BACKGROUND: Proximal migration of pancreatic stent (PMPS) is an infrequent event but its management can be technically challenging and there are no standard retrieval methods. This study aimed to determine the results of an endoscopic stent retrieval algorithm in terms of feasibility and efficacy of the endoscopic procedure. METHODS: During the period from January 2008 to December 2009, 15 patients (8 women and 7 men with a mean age of 51.9 years) with PMPS were included in this study. Stent retrieval was approached initially with balloon extraction followed by rat-tooth forceps and basket. A rescue approach such as using a stent retriever was attempted when other approaches failed. RESULTS: All the PMPSs (six 5Fr, nine 7Fr) were retrieved successfully within one ERCP session. Balloon extraction was successful in 9 (60%) patients. In the 6 failed cases of balloon extraction, wire-guided rat-tooth forceps grasp was successful in 4, and stone extraction basket grasp was successful in 1 in whom forceps grasp failed. One stent was finally rescued with a stent retriever when balloon extraction, forceps and basket grasp all failed. In patients with successful balloon extraction, 44.4% (4/9) developed post-ERCP hyperamylasemia but none of them developed post-procedure pancreatitis. CONCLUSIONS: With this algorithm, 5Fr and 7Fr PMPS were successfully retrieved in all of the patients. Most PMPSs can be safely retrieved with the commonly-used approaches in this study. Those less used approaches can be used as a rescue method.