Narrow-band imaging for scar (NBI-SCAR) classification: from conception to multicenter validation.

BACKGROUND AND AIMS: Surveillance post-endoscopic resection (ER) currently warrants biopsy samples from the resection site scar in most cases, although clinical practice is variable. A classification with standard criteria for scars has not yet been established. We aimed to create and validate a novel classification for post-ER scars by using specific criteria based on advanced imaging. METHODS: Key endoscopic features for scars with and without recurrence were (1) dark brown color, elongated/branched pit pattern, and dense capillary pattern and (2) whitish, pale appearance, round/slightly large pits, and irregular sparse vessels. Scars were first assessed with high-definition white-light endoscopy (HD-WLE) followed by interrogation with narrow-band imaging (NBI). Scars with at least 2 concordant characteristics were diagnosed with "high confidence" for NBI for scar (NBI-SCAR) classification. The final endoscopic predictions were correlated with histopathology. The primary outcome was the difference in sensitivity between NBI-SCAR and HD-WLE predictions. Secondary outcomes included the validation of our findings in 6 different endoscopy settings (Australia, United States, Japan, Brazil, Singapore, and Malaysia). The validation took place in 2 sessions separated by 2 to 3 weeks, each with 10 one-minute videos of post-ER scars on underwater NBI with dual focus. Inter-rater and intrarater reliability were calculated with Fleiss' free-marginal kappa and Bennett et al. S score, respectively. RESULTS: One hundred scars from 82 patients were included. Ninety-five scars were accurately predicted with high confidence by NBI-SCAR in the exploratory phase. NBI-SCAR sensitivity was significantly higher compared with HD-WLE (100% vs 73.7%, P < .05). In the validation phase, similar results were found for endoscopists who routinely perform colonoscopies and use NBI (sensitivity of 96.4%). The inter-rater and intrarater reliability throughout all centers were, respectively, substantial (κ = .61) and moderate (average S = .52) for this subset. CONCLUSIONS: NBI-SCAR has a high sensitivity and negative predictive value for excluding recurrence for endoscopists experienced in colonoscopy and NBI. In this setting, this approach may help to accurately evaluate or resect scars and potentially mitigate the burden of unnecessary biopsy samples.

Endoscopic sleeve gastroplasty in the management of overweight and obesity: an international multicenter study.

BACKGROUND AND AIMS: Obesity is a pandemic affecting approximately 700 million adults worldwide, with an additional 2 billion overweight. Endoscopic sleeve gastroplasty (ESG) is a minimally invasive endoscopic bariatric therapy that involves remodeling of the greater curvature in an effort to reduce gastric capacity and delay gastric emptying. A variety of ESG suture patterns has been reported. This study is the first to use a uniform "U" stitch pattern across all centers to simplify technical aspects of the procedure and limit cost. This also uniquely assessed outcomes in all body mass index (BMI) categories and changes in metabolic rate, lean body mass, and adipose tissue composition. METHODS: This is a multicenter analysis of prospectively collected data from 7 centers including patients with overweight and obesity who underwent ESG. Primary outcomes included absolute weight loss, percent total body weight loss (%TWL), change in BMI, and percent excess weight loss (%EWL) at 6 and 12 months in overweight and obese classes I, II, and III. Secondary outcomes included adipose tissue, lean body mass reduction, and metabolic rate analyzed by bioimpedance. Additionally, immediate or delayed adverse events (AEs) were analyzed. Clinical success was defined as achieving ≥25% EWL at 1 year with ≤5% serious AE (SAE) rate following the American Society for Gastrointestinal Endoscopy (ASGE)/American Society for Metabolic and Bariatric Surgery (ASMBS) threshold. RESULTS: A total of 193 patients underwent ESG during the study period. All groups had >10% TWL and >25% EWL at 6 months of follow-up. On average, %TWL was 14.25% ± 5.26% and 15.06% ± 5.22% and the %EWL 56.15% ± 22.93% and 59.41% ± 25.69% at 6 months and 1 year of follow-up, respectively. %TWL was 8.91% ± .3%, 13.92% ± 5.76%, 16.22% ± 7.69%, and 19.01% ± .95% and %EWL 56.21% ± 2.0%, 62.03% ± 27.63%, 54.13% ± 23.46%, and 46.78% ± 2.43% for overweight and obesity classes I, II, and III, respectively, at 1 year. Male sex, age <41 years, and higher BMI were predictors of achieving a TWL ≥10% at 1-year follow-up. There was a significant reduction in adipose tissue from baseline. SAEs occurred in 1.03%, including 2 perigastric collections needing surgery. CONCLUSIONS: ESG appears to be feasible, safe, and effective in the treatment of patients with overweight and obesity according to ASGE/ASMBS thresholds.

Efficacy of the cardiac septal occluder in the treatment of post-bariatric surgery leaks and fistulas.

BACKGROUND: Endoscopy has evolved to become first-line therapy for the treatment of post-bariatric leaks; however, many sessions are often required with variable success rates. Due to these limitations, the use of the cardiac septal defect occluder (CSDO) has recently been reported in this population. METHODS: The study population was a multicenter retrospective series of patients with post-bariatric surgical leaks who underwent treatment with CSDO placement. Data on the type of surgery, previous treatment details, fistula dimensions, success rate, and adverse events were collected. Leaks were grouped according to the International Sleeve Gastrectomy Expert Panel Consensus. Outcomes included technical and clinical success and safety of the CSDO. Regression analysis was performed to determine the predictors of response. RESULTS: Forty-three patients with leaks were included (31 sleeve gastrectomy and 12 Roux-en-Y gastric bypass). They were divided into acute (n = 3), early (n = 5), late (n = 23), and chronic (n = 12). Forty patients had failed previous endoscopic treatment and 3 patients had CSDO as the primary treatment. Median follow-up was 34 weeks. Technical success was achieved in all patients and clinical success in 39 patients (90.7%). All chronic, late, and early leaks were successfully closed, except one undrained late leak. The 5 patients with early leaks had an initial satisfactory response, but within 30 days, drainage recurred. The CSDOs were removed and replaced with larger-diameter devices leading to permanent defect closure. Acute leaks were not successfully closed in all 3 patients. Regression analysis showed that chronicity and previous treatment were associated with fistula closure; success rates for late/chronic leaks versus acute/early leaks were 97.1% and 62.5%, respectively (P = .0023). CONCLUSION: This observational study found that the CSDO had a high efficacy rate in patients with non-acute leaks, with no adverse events. All early, late, and chronic leaks were successfully closed, except for one undrained late leak. However, early leaks required a second placement of a larger CSDO in all cases. These results suggest that the CSDO should be considered for non-acute fistula and that traditional closure methods are likely preferred in the acute and early settings.

Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy Treatments for Obesity: Systematic Review and Meta-Analysis of Short- and Mid-Term Results.

BACKGROUND: Laparoscopic greater curvature plication (LGP) has recently emerged as a new bariatric procedure. This surgery provides gastric restriction without resection, which could potentially provide a lower risk alternative, with fewer complications. The real benefit of this technique in the short and long term is unknown. This systematic review aims to compare laparoscopic gastric plication and laparoscopic sleeve gastrectomy for obesity treatment. METHODS: Clinical trials were identified in MEDLINE, Embase, Cochrane, LILACS, BVS, SCOPUS, and CINAHL databases. Comparison of LGP and laparoscopic sleeve gastrectomy (SG) included hospital stay, operative time, loss of hunger feeling, body mass index loss (BMIL), percentage of excess weight loss (%EWL), complications, symptoms in the postoperative period, and comorbidity remission or improvement. RESULTS: This systematic review search included 17,423 records. Eight studies were selected for meta-analysis. There is no difference in operative time, hospital stay, and complications. Patients in the SG group had improved loss of hunger feeling. BMIL was better in the SG group at 12 and 24 months [mean difference (MD) - 2.19, 95% confidence interval (CI) - 3.10 to - 1.28, and MD - 4.59, 95% CI - 5.55 to - 3.63, respectively]. SG showed improved %EWL compared with gastric plication in 3, 6, 12, and 24 months. However, no difference was found in %EWL long-term results (24 and 36 months). Patients who underwent LGP had more sialorrhea. SG showed better results in diabetes remission. CONCLUSIONS: SG showed improved weight loss when compared with LGP, with better satiety, fewer symptoms in the postoperative period, and improved diabetes remission.

Primary adenosquamous cell carcinoma of the pancreas: the use of endoscopic ultrasound guided - fine needle aspiration to establish a definitive cytologic diagnosis / Carcinoma adenoescamoso primario de páncreas: uso de la técnica de biopsia por aspiración con aguja fina guiada por ultrasonido endoscópico para establecer un diagnóstico citológico definitivo

Pancreatic cancer is the second most common malignancy of the gastrointestinal tract in the US, and adenocarcinoma has been identified as the most common type of pancreatic cancer. Different types of pancreatic cancers have been classified: adenocarcinoma, ductal adenosquamous carcinoma, solid pseudopapillary tumors, endocrine neoplasms, acinar cell carcinoma, squamous cell carcinoma, cystic tumors, primary lymphoma of the pancreas, and metastatic lesions of the pancreas. Adenosquamous carcinoma is extremely rare, behave in a very aggressive way and is responsible for the 1 to 4% of the pancreatic exocrine neoplastic lesions. We describe the case of an 82-years-old African American female, presenting to our institution with quantifiable weight loss (12 kg in 3 months), jaundice and abdominal pain. On admission, laboratory tests were obtained: total bilirubin: 11.07 mg/dl with a direct fraction of 10.32 mg/dl. Cross-sectional abdominal CT scan with contrast, showed a lesion localized in the pancreatic head (hypodense on T1, measuring 3.5 x 3.5 x 2.5 cm), with vascular invasion of the portal vein. EUS showed a solid, hypoechoic, not well-defined lesion (measuring 3.98 x 3.80 cm), localized between the head and neck of the pancreas. EUS-FNA was performed with a 22G needle using the fanning technique. The cytological specimens demonstrated components of both squamous carcinoma and adenocarcinoma. The patient underwent ERCP procedure, and biliary drainage was performed with an entirely covered metallic stent placement. After a month from the procedures, the patient died due to the severity of the disease. Endoscopic ultrasound has proven to be the best method to diagnose solid pancreatic lesions, including rare and aggressive type of tumors like primary adenosquamous cell carcinoma that we described in this very interesting case report

El cáncer de páncreas es la segunda neoplasia maligna más común del tracto gastrointestinal en los EE.UU. y el adenocarcinoma ha sido identificado como el tipo más común de cáncer de páncreas. Se han clasificado diferentes tipos de cáncer de páncreas: adenocarcinoma, carcinoma adenoescamoso ductal, tumores pseudopapilares sólidos, neoplasias endocrinas, carcinoma de células acinares, carcinoma de células escamosas, tumores quísticos, linfoma primario del páncreas y lesiones metastásicas del páncreas. El carcinoma adenoescamoso es extremadamente raro y se comporta de manera muy agresiva, es responsable del 1 al 4% de las lesiones pancreáticas exocrinas neoplásicas. Presentamos el caso de una mujer afroamericana de 82 años de edad, que fue admitida a nuestra institución con pérdida de peso cuantificable (12 kg en 3 meses), ictericia y dolor abdominal. Al momento de la admisión, se obtuvieron pruebas de laboratorio: bilirrubina total: 11,07 mg/dl con una fracción directa de 10,32 mg/dl. La tomografía computarizada abdominal transversal con contraste mostró una lesión localizada en la cabeza pancreática (hipodensa en T1, 5 x 3,5 x 2,5 cm) con invasión vascular de la vena porta. El ultrasonido endoscópico mostró una lesión sólida, hipoecoica, no bien definida de 3,98 x 3,80 cm, localizada entre la cabeza y el cuello del páncreas. La biopsia por aspiración con aguja fina guiada por ultrasonido endoscópico se realizó con una aguja 22G utilizando la técnica de ventilación (Fanning). Los especímenes citológicos demostraron componentes de carcinoma escamoso y adenocarcinoma. El paciente se sometió a CPRE y el drenaje biliar se realizó con una prótesis metálica completamente cubierta. Después de un mes de los procedimientos, el paciente falleció debido a la gravedad de la enfermedad. El ultrasonido endoscópico ha demostrado ser el mejor método para diagnosticar lesiones pancreáticas sólidas, incluyendo tumores raros y agresivos como el carcinoma primario de células adenoescamosas que describimos en este interesante relato de caso

Estudio comparativo entre el uso de manitol y el picosulfato sódico como preparación para colonoscopía / Comparison of colon-cleansing methods in preparation for colonoscopy- comparative of solutions of mannitol and sodium picosulfate

Objetivos: El objetivo del presente estudio es comparar la preparación adecuada del colon con manitol y picosulfato sódico. Evaluar la aceptación de los pacientes, los efectos secundarios y la capacidad de limpieza. Materiales y métodos: Este es un estudio no aleatorio, prospectivo, ciego, en que el evaluador no tenía información sobre la preparación aplicada. La muestra obtenida se dividió en dos grupos de acuerdo con la preparación adecuada del colon, con 153 pacientes preparados con manitol al 10% y 84 pacientes con picosulfato sódico. La evaluación de la preparación se realizó usando la Escala de Boston (Boston Bowel Preparation Scale - BBP) a través de un sistema de puntuación para cada región del colon puntuada con 3 puntos: derecha, izquierda y colon transverso. Resultados: De los 237 pacientes que fueron evaluados, 146 (61,60%) eran mujeres y 91 (38,4%) eran hombres. En el grupo que utilizó manitol, 98 (64,05%) eran mujeres y 55 (35,95%) eran varones. Entre los pacientes que utilizaron picosulfato sódico, 48 (57,14%)eran mujeres y 36 (42,86%) eran hombres, sin diferencias estadísticas de ambos grupos (p>0,32). Teniendo en cuenta que con la adecuada preparación del colon y con puntuación de 6 puntos en la Escala de Boston, la preparación intestinal fue satisfactoria en ambos grupos. El 93% de los pacientes que utilizaron manitol y el 81% de los pacientes que utilizaron picosulfato sódico tenían preparación adecuada (puntuación de 6). La puntuación media en la preparación con manitol fue de 9 y en la preparación con picosulfato sódico fue de 7. No hubo diferencias significativas entre ambos grupos. Conclusión: Ambas preparaciones, demostraron ser seguras y eficaces para la limpieza del intestino, de acuerdo con la Escala de Boston, así como, la aceptabilidad de los pacientes y libre de complicaciones

Objectives: The purpose of the present study is to compare intestinal preparation with mannitol and sodium picosulphate, assessing patient’s acceptance, side effects and cleaning capacity. Material and methods: This is a prospective, nom randomized, blind study, in which the evaluator had no information about the preparation applied. The sample obtained was divided into two groups according to the bowel preparation applied, with 153 patients prepared with 10% mannitol and 84 patients with sodium picosulfate. The evaluation of colon preparation was done using the Boston Scale (Boston Bowel Preparation Scale - BBP) through a three-point scoring system for each of the three regions of the colon: right, left and transverse colon. Results: Of the 237 patients that were evaluated, 146 (61.60%) were female and 91 (38.4%) were male. Regarding the group that used mannitol, 98 were female (64.05%) and 55 were male (35.95%). Among the patients who used sodium picosulfate, 48 were female (57.14%) and 36 were male (42.86%), with no statistical differences between both groups (p> 0.32). Considering that an adequate preparation scores ≥ 6 in the Boston Scale, the bowel cleansing preparation was satisfactory in both groups. 93% of the patients who used mannitol and 81% of the patients who used sodium picosulfate had adequate preparation (score of ≥ 6). Moreover, we consider that the average score in the preparation with Mannitol was 9, while the sodium picosulfate score was 7. There were no significant differences between the two groups. Conclusion: There is consensus among authors who state that colonoscopy’s safety and success are highly related to the cleansing outcome, regardless of the method used. The same can be observed in the present study, on which both preparations were proved safe and effective for bowel cleansing, according to the Boston scale, as well as accepted by patients and free of complications

SURGERY VERSUS ENDOSCOPIC THERAPIES FOR EARLY CANCER AND HIGH-GRADE DYSPLASIA IN THE ESOPHAGUS: a systematic review.

BACKGROUND: Esophageal cancer occurs as a local disease in 22% of cases, and a minority of this disease is limited to the mucosa or submucosa (early lesions). Endoscopic mucosal resection, endoscopic submucosal dissection, photodynamic therapy, laser therapy, and argon plasma coagulation have emerged as alternatives to surgical resection for early lesions. OBJECTIVE: The aim of this systematic review is to identify studies that statistically compare survival, disease-free survival, morbidity and mortality associated with the procedure, and mortality associated with cancer in the endoscopic versus surgical therapies. DATA SOURCES: A systematic review using MEDLINE, COCHRANE, EMBASE, EBSCO, LILACS, Library University of Sao Paulo, BVS, and SCOPE. STUDY SELECTION: Randomized controlled trial, controlled clinical trial, clinical trial, and cohort study. CRITERIA: - Studies that statistically compare survival, disease-free survival, morbidity and mortality associated with the procedure, and mortality associated with cancer in patients who underwent endoscopic and surgical therapy for early lesions of esophageal cancer. DATA EXTRACTION: Independent extraction of the articles by two authors using predefined data fields, including study quality indicators. LIMITATION: Only retrosprospective cohort studies comparing the endoscopic and surgical therapies were recovered. RESULTS: The survival rates after 3 and 5 years were different and exhibited superiority with the surgical therapies over time. Endoscopy is superior in the control of mortality related to cancer with a high rate of disease recurrence. With regard to the comorbidity and the mortality associated with the procedure, endoscopy is superior. CONCLUSION: There is no evidence from clinical trials. In this systematic review, surgical therapies showed superiority for survival, and endoscopic therapies showed superiority in the control of mortality related to cancer with a high rate of disease recurrence; also, for the comorbidity and the mortality associated with the procedure, endoscopy is superior. Prospective, controlled trials with large sample sizes are necessary to confirm the results of the current analysis.

Surgery versus endoscopic therapies for early cancer and high-grade dysplasia in the esophagus: a systematic review

ABSTRACT Background Esophageal cancer occurs as a local disease in 22% of cases, and a minority of this disease is limited to the mucosa or submucosa (early lesions). Endoscopic mucosal resection, endoscopic submucosal dissection, photodynamic therapy, laser therapy, and argon plasma coagulation have emerged as alternatives to surgical resection for early lesions. Objective The aim of this systematic review is to identify studies that statistically compare survival, disease-free survival, morbidity and mortality associated with the procedure, and mortality associated with cancer in the endoscopic versus surgical therapies. Data sources A systematic review using MEDLINE, COCHRANE, EMBASE, EBSCO, LILACS, Library University of Sao Paulo, BVS, and SCOPE. Study selection Randomized controlled trial, controlled clinical trial, clinical trial, and cohort study. Criteria - Studies that statistically compare survival, disease-free survival, morbidity and mortality associated with the procedure, and mortality associated with cancer in patients who underwent endoscopic and surgical therapy for early lesions of esophageal cancer. Data extraction Independent extraction of the articles by two authors using predefined data fields, including study quality indicators. Limitation Only retrosprospective cohort studies comparing the endoscopic and surgical therapies were recovered. Results The survival rates after 3 and 5 years were different and exhibited superiority with the surgical therapies over time. Endoscopy is superior in the control of mortality related to cancer with a high rate of disease recurrence. With regard to the comorbidity and the mortality associated with the procedure, endoscopy is superior. Conclusion There is no evidence from clinical trials. In this systematic review, surgical therapies showed superiority for survival, and endoscopic therapies showed superiority in the control of mortality related to cancer with a high rate of disease recurrence; also, for the comorbidity and the mortality associated with the procedure, endoscopy is superior. Prospective, controlled trials with large sample sizes are necessary to confirm the results of the current analysis.

RESUMO Contexto Cerca de 22% dos casos de câncer esofágico ocorrem como uma doença local e uma minoria é considerada lesão precoce, isto é, está limitada à mucosa ou submucosa. A ressecção endoscópica da mucosa, dissecção endoscópica da submucosa, a terapia fotodinâmica, a terapia laser e coagulação com plasma de argônio se desenvolveram como alternativas à ressecção cirúrgica para lesões precoces. Objetivo O objetivo desta revisão sistemática é identificar estudos que comparam terapia endoscópica com terapia cirúrgica, quanto à sobrevivência, à sobrevivência livre de doença, à morbidade e a mortalidade associada ao procedimento e a mortalidade associada ao câncer. Fontes de dados - Revisão sistemática utilizando MEDLINE, COCHRANE, EMBASE, EBSCO, LILACS, Biblioteca da Universidade de São Paulo, BVS e ESCOPE. Seleção de estudo Estudo randomizado controlado, ensaio clínico e estudo de coorte. Critérios Estudos que comparam a sobrevivência, a sobrevivência livre de doença, a morbidade e a mortalidade associadas ao procedimento e mortalidade associada ao câncer na endoscópica e terapia cirúrgica para lesões precoces de câncer de esôfago. Extração de dados Extração independente de artigos com dois autores usando campos de dados pré-definidos, incluindo indicadores de qualidade do estudo. Limitação Somente estudos de coorte retrospectivos comparando endoscopia e a cirurgia foram recuperados. Resultados As taxas de sobrevida após 3 e 5 anos foram diferentes e mostrou-se superioridade das terapias cirúrgicas em relação às endoscópicas ao longo do tempo. A endoscopia é superior no controle da mortalidade relacionada ao câncer com alta taxa de recorrência da doença. Em relação à morbidade e mortalidade associadas ao procedimento, a endoscopia é superior. Conclusão Não há evidências de ensaios clínicos. Esta revisão sistemática mostrou superioridade na sobrevivência das terapias cirúrgicas. As terapias endoscópicas evidenciam superioridade no controle da mortalidade relacionada ao câncer com uma alta taxa de recorrência da doença. Além disso, a endoscopia correlaciona-se com menor morbidade e mortalidade associadas à intervenção. Ensaios controlados com grandes amostras são necessários para confirmar os resultados da análise atual.

Systematic review and meta-analysis of endoscopic ablative treatment of Barrett’s esophagus / Revisión sistemática y meta-análisis del tratamiento ablativo endoscópico del esófago de Barrett

Background: Barrett’s esophagus (BE) is the main risk factor for esophageal adenocarcinoma. Its therapeutic approach is controversial and surgical treatment in the presence of high-grade intraepithelial neoplasia may be indicated. Endoscopic approach is an alternative with lower mortality and morbidity rates and favorable results. Objective: To define the best option, according to literature, to treat Barrett’s Esophagus. Materials and methods: Design: Systematic review of PUBMED, EMBASE, LILACS, and Cochrane Library databases was conducted and articles of randomized, controlled studies on BE endoscopic ablative treatment were selected. The systematic review through PUBMED retrieved results with higher evidence level and available recommendation grade regarding BE ablative therapy. Nine articles on randomized, controlled studies classified as A or B according to the Oxford table were selected. Cryotherapy, laser, photodynamic therapy (PDT), multipolar electrocoagulation (MPEC), and ablation through argon plasma coagulation (APC) and radiofrequency were considered ablation therapies. Patients: 649 patients from 10 different studies were analysed. Results: PDT was found to present an increase in treatment failure compared with APC, NNH = -7. BE ablation through MPEC or APC was found to have similar risk for treatment failure in meta-analysis. PDT associated with proton pump inhibitor (PPI) is beneficial for BE ablation regarding PPI use alone, NNT = 2. Radiofrequency with PPI is an efficient method to reduce risk of treatment failure, NNT = 1. Conclusions: There are no studies demonstrating the benefit of indicating cryotherapy or laser therapy for BE endoscopic approach. APC ablation was found to have superior efficacy compared with PDT and ablation through APC and MPEC was found to present effective, similar results. Radiofrequency is the most recent approach requiring comparative studies for indication.

Introducción: El esófago e Barrett (BE) es un factor de riesgo importante para adenocarcinoma de esófago.Su manejo terapéutico es controversial y el tratamiento quirúrgico en la presencia de neoplasia intraepitelial de alto grado puede estar indicado. El manejo endoscópico es una alternative con menores tasas de morbilidad y mortalidad y con resultados favorables. Objetivo: Definir la major opción de tratamiento del esófago de Barrett de acuerdo a la literatura. Materiales y métodos: Diseño: Se realize una revisión sistemática de PUBMED, EMBASE, LILACS yla librería Cochrane y los artículos randomizados, controlados en ablación endoscópica de BE fueron seleccionados. Esta revisión de PUBMED mostró resultados de una evidencia muy alta y recomendación alta para el uso de terapia ablativa. Nueve artículos de studios randomizados y controlados fueron catalogados grado A o B de aacuerdo a la table de Oxford y fueron seleccionados.Fueron consideradas como terapia ablativa, la crioterapia, laser,terapia fotodinámica (PDT),electrocoagulación multipolar (MPEC) ,ablación con coagulación por argón plasma (APC) y radiofrecuencia. Pacientes: 649 pacientes de 10 estudios diferentes fueron analizados. Resultados: El PDT se halló que tenía mas fallas que el APC , NNH=-7. La ablación del esófago de barrett por MPEC o APC tuvieron el mismo riesgo de fracaso terapéutico en los meta-análisis.La PDT asociado al uso de Inhibidores de bomba de protones (PPI) es beneficiosa versus el uso de, los PPI solos, NNT=2. La radiofrecuencia con PPI es un método eficiente para reducer el riesgo de fracas terapéutico, NNT=1. Conclusiones: No hay studios que demuestren el beneficio de la crioterapia o la terapia con laser para el esófago de Barrett, se encontró que tiene una eficacia superior comparada con el PDT y la ablación por APC y MPEC tenían resultados efectivos y similares.La radiofrecuencia es el manejo más reciente y requiere estudios comparativos para su indicación.

Stents for benign and malignant esophageal strictures.

This paper presents commentaries on endotherapy for esophageal perforation/leaks; treatment of esophageal perforation; whether esophageal stents should be used for treating benign esophageal strictures; what determines the optimal stenting period in benign esophageal strictures/leaks; how to choose an esophageal stent; how a new fistula secondary to an esophageal stent should be treated; which strategy should be adopted when a fistula of a cervical anastomosis occurs; intralesional steroids for refractory esophageal strictures; balloon and bougie dilators for esophageal strictures and predictors of response to dilation; whether refractory strictures from different etiologies respond differently to endotherapy; surgical therapy of benign esophageal strictures; and whether stenoses following severe esophageal burns should be treated by esophageal resection or esophageal bypass.