bluuebunny/crossref_metadata_2025_split huggingface dataset:
870 The Efficacy and Safety of Endoscopic Submucosal Dissection for Early Gastric Cancer in Patients With Cirrhosis: A Systematic Review and Meta-Analysis
Authors: Laoveeravat Passisd , Perisetti Abhilash , Vutthikraivit Wasawat , Garcia-Saenz-de-Sicilia Mauricio , Garg Shashank , Thandassery Ragesh , Inamdar Sumant , Wongjarupong Nicha , Tharian Benjamin 
Published: October 2019

INTRODUCTION:
Cirrhosis is known to increase the risk of bleeding and mortality from procedures. Endoscopic submucosal dissection (ESD) is an approved minimally invasive treatment of early gastric neoplasm. The safety and complications of ESD in cirrhotics in this setting has not been mentioned in the guidelines. We aimed to address it in this meta-analysis.

METHODS:
We searched the databases of MEDLINE, EMBASE, and CENTRAL from inception to May 2019. A manual review of included studies and references were performed. The inclusion criteria were published studies comparing the efficacy and safety of ESD for gastric cancer in cirrhosis and non-cirrhotics. The outcomes were En bloc resection, R0 resection, post-ESD bleeding, perforation, and mortality rate. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate pooled risk ratio (RR) and 95% confidence intervals (CI).

RESULTS:
Of 14 included observational studies, four included compensated cirrhosis patients and ten did not mention cirrhosis status. Major etiologies of cirrhosis were hepatitis B infection (49%). Mean platelet counts in compensated cirrhotics was 113000/uL. Cirrhotics have higher risk of post-ESD bleeding compared to others with pooled RR (95% CI) of 1.43 (1.02-2.00, I

2
= 0%) (Figure 1). In subgroup analysis of compensated cirrhosis, the bleeding risk is not different between the groups, pooled RR (95% CI) of 1.22 (0.70-2.12, I

2
= 0%) (Figure 2). The data of decompensated cirrhosis is not available. On the contrary, perforation risk is comparable between the groups with pooled RR (95% CI) of 2.08 (0.51-8.43, I

2
= 0%). ESD procedure time is not different between two groups. We found that the efficacies, En bloc and R0 resection, are not different between cirrhosis and non-cirrhosis with pooled RR (95% CI) of 1.01 (0.97-1.04, I

2
= 12.1%) and 0.98 (0.92-1.04, I

2
= 0%), respectively. The procedure related mortality rate in both cirrhosis and non-cirrhosis patients are 0%.

CONCLUSION:
Post-ESD bleeding in cirrhosis is a concerning complication as expected in early gastric cancer; but the risk of bleeding in compensated cirrhosis is similar to non-cirrhotics. Perforation and mortality are not different compared to controls. In terms of efficacy, no differences are found between patients with and without cirrhosis. Further studies on subgroup analysis of decompensated cirrhosis are warranted.
874 Sensitivity of Endoscopic Modalities for Diagnosis of Malignant Biliary Strictures: Experiences From Referral Hospitals in Eastern and Western Countries
Authors: Angsuwatcharakon Phonthep , Ahmed Osman , Maytapa Jeerawat , Ross William , Weston Brian , Ridtitid Wiriyaporn , Kongkam Pradermchai , Rerknimitr Rungsun , Stroehlein John , Lee Jeffrey H. 
Published: October 2019

INTRODUCTION:
Indeterminate biliary strictures require further investigations to exclude malignancy. Cholangioscopy allows direct visualization of the bile duct as well as the ability to target the specific area for biopsy. This study aims to evaluate the sensitivity of endoscopic modalities including cholangioscopy-guided (miniature) biopsies ± brushings and/or fluoroscopy-guided biopsy (regular) biopsies for diagnosis of malignant biliary strictures in a real-world practice.

METHODS:
Endoscopy databases between 2015-2018 from two referral hospitals, one in USA and the other in Thailand, were retrospectively reviewed. Patients with indeterminate biliary stricture underwent ERCP and digital cholangioscopy-guided biopsy were included. Malignancy was confirmed by cytology or histology obtained by ERCP, surgery, or intervention-guided biopsy. Benign disease was confirmed by no disease progression and patient survived more than 6 months.

RESULTS:
A total of 58 patients (USA = 20 and Thailand = 38) with indeterminate biliary stricture underwent ERCP and cholangioscopy-guided biopsy were included. Forty-three patients had malignant strictures and 15 patients had benign strictures. The most common cause of malignant biliary stricture was cholangiocarcinoma (76.7%) and the most common cause of benign biliary stricture was IgG4-sclerosing cholangitis (46.7%). The majority of tissue acquisition was obtained by a combination of miniature biopsies + brushings + regular biopsies in 24 patients (41.4%) followed by a combination of miniature biopsies + regular biopsies in 20 patients (34.5%). Miniature biopsies alone was more frequently used in the USA site (30%) when compare with the Thailand site (5.3%). Sensitivity per methods of tissue acquisition were 12%, 48.8%, and 64.7% in brushings, miniature biopsies, and regular biopsies, respectively. Brushings had the lowest sensitivity in both centers (0% in USA and 18.8% in Thailand). Miniature biopsies had the highest sensitivity in the USA site (42.9%) and biopsy had the highest sensitivity in the Thailand site (65.4%). A combination of tissue acquisition methods provided the highest sensitivity, which was able to increase the sensitivity up to 10.5%.

CONCLUSION:
Cholangioscopy-guided biopsies are able to diagnose cancer in a half of patient who presented with indeterminate biliary stricture. Nevertheless, a combination of miniature biopsies with other tissue acquisition methods was more commonly utilized and had higher diagnostic yield than miniature biopsy alone.
875 Efficacy and Safety of Endoscopic Ultrasound (EUS) Guided Gastroenterostomy (GE): A Systematic Review and Meta-Analysis
Authors: Krishnamoorthi Rajesh , Jayaraj Mahendran , Gopalakrishnan Ravikumar Naveen Prasad , Singh Dhruv , Law Joanna , Larsen Michael , Ross Andrew , Kozarek Richard , Irani Shyan 
Published: October 2019

INTRODUCTION:
Endoscopic ultrasound (EUS) guided gastroenterostomy (GE) is emerging as an alternative to enteral stenting and surgical GE for management of malignant gastric outlet obstruction (GOO). With advances in EUS technology and availability of dedicated devices/stents for EUS scopes, the use of EUS-GE is expected to increase in the future. We performed a systematic review and meta-analysis to estimate the success rate and adverse events associated with EUS-GE.

METHODS:
We conducted a comprehensive search of multiple electronic databases and conference proceedings including PubMed, EMBASE, and Web of Science databases (from inception through May 2019) to identify studies that reported success rate and adverse events of EUS-GE. The primary outcome was to estimate the pooled rates of technical and clinical success of EUS-GE. The secondary outcome was to estimate the rate of adverse events.

RESULTS:
9 studies with a total of 268 patients were included. The pooled rate of technical success of EUS-GE was 91.7 % (95% CI 87.5 – 94.5; I2 = 0). The pooled rate of clinical success of EUS-GJ was 87.8% (95% CI 83.1 – 91.3; I2 = 0). The pooled rate of overall adverse events was 12.6% (95% CI 9.0- 17.6; I2 = 0). The pooled rate of individual adverse events – perforation, bleeding, peritonitis and stent migration / misdeployment were 2% (95% CI 0.7 – 5.1), 3.2% (95% CI 1.5 – 6.5), 2.6% (95% CI 1.1-6.1) and 8.9 % (95% CI 4.3-17.5) respectively.The rate of surgical intervention for adverse events was 2%.

CONCLUSION:
While the rates of technical success (92%) and clinical success (88%) of EUS-GJ is promising, the risk of adverse events is considerable at 12.6%, with stent misdeployment (9%) being the most common adverse event. Hence, EUS-GJ should be performed at tertiary referral centers in a multidisciplinary (surgery, oncology, gastroenterology) team-based approach.
876 A Nationwide Landscape of Cardiopulmonary Complications Following Endoscopic Retrograde Cholangiopancreatography (ERCP)
Authors: Patel Harsh K. , Desai Rupak , Doshi Shreyans , Vyas Ankit , Vyas Manan , Goyal Hemant 
Published: October 2019

INTRODUCTION:
Cardiopulmonary complications by and large account for higher endoscopic retrograde cholangiopancreatography (ERCP)–related complications in small-scale studies. However, the reported incidence remains quite low in large clinical studies due to lack of consensus definitions to report cardiopulmonary complications. We assessed the trends in age (18-44, 45-64, and ≥65 years), gender and race-specific cardiopulmonary complications and inpatient mortality using the largest inpatient cohort in the United States.

METHODS:
ERCP procedures (diagnostic and therapeutic) among adults and subsequent cardiopulmonary complications were identified using weighted data from the National Inpatient Sample (NIS) (2007-2014) and ICD-9-CM codes. Cardiopulmonary complications comprised of postoperative cardiac complications, periprocedural myocardial infarction, cardiac arrest including ventricular tachycardia/fibrillation/flutter, postprocedural hypotension, venous thromboembolism, hypoxemia, air embolism, and aspiration pneumonia. Trends in complications and mortality were analyzed using a linear-by-linear association in SPSS v.22 (IBM Corp, NY, USA). A two-tailed P ≤ 0.05 was considered clinically significant.

RESULTS:
In a total of 1,374,773 ERCP procedures (mean age 59 years; 60% males) performed during the 8-year study period, at least one cardiopulmonary complication was documented in 53,981 (3.9%) procedures. The highest rate was documented in patients aged ≥65 yrs (5.7%) with overall steady incidence rates throughout the study period (Figure 1). The overall mortality rate was significantly higher (8.5% vs. 1.2%, P < 0.001) among those who suffered any cardiopulmonary complication compared to those who did not. However, the inpatient mortality rates declined for both groups (from 9.1% to 7.1% and 1.4% to 1.1%, respectively) between 2007 and 2014 (Ptrend< 0.001) (Figure 2A). Males (4.8% vs. 3.4%) and white race group (4.2% vs. 3.7%) showed higher complications compared to females and another race groups, respectively (P < 0.001) (Figure 2B).

CONCLUSION:
This retrospective large cohort study revealed a 3.9% incidence rate of post-ERCP cardiopulmonary complications with an overall mortality rate of 8.5%. There was a steady trend in ERCP-related cardiopulmonary complications with a reassuringly declining trend in the inpatient mortality following cardiopulmonary complications. These findings warrant future studies and a goal of embracing preventive measures in a timely manner to curtail cardiopulmonary complications.
880 EUS-Guided Through-The-Needle Microforceps Biopsy Versus EUS-FNA in the Evaluation of Pancreas Cysts: A Meta-Analysis
Authors: Ponniah Sandeep A. , Westerveld Donevan , Draganov Peter V. , Yang Dennis 
Published: October 2019

INTRODUCTION:
Accurate diagnosis and risk stratification of pancreas cysts (PCs) is crucial for management. A through-the-needle microforceps was recently introduced for endoscopic ultrasound (EUS)-guided tissue sampling of PCs. We performed a meta-analysis to evaluate the efficacy and safety of microforceps biopsy (TTNB) and compare its diagnostic outcomes with EUS-guided fine-needle aspiration (FNA).

METHODS:
Comprehensive search of electronic databases (PubMed, EMBASE, Cochrane, Web of Science) from inception to May 2019 to identify studies that reported on EUS-guided TTNB. Main outcomes included comparison of pooled rates of specific diagnosis and that of mucinous PCs with TTNB vs FNA. Secondary outcomes included concordance between TTNB, FNA with available surgical histopathology. Pooling was conducted using either fixed- or random-effects model depending on heterogeneity across studies.

RESULTS:
Seven studies including 365 patients were included. TTNB was technically feasible in 98% of the cases. A specific PC diagnosis was more frequently obtained with TTNB vs EUS-FNA (OR: 6.35; 95% CI: 4.47-9.01, I2 = 0). Similarly, diagnosis of a mucinous PC was most commonly obtained with TTNB vs. EUS-FNA (OR: 3.01; 95% CI: 1.32-6.86, I2 = 80%). Sixty-four of the 365 patients with PC underwent surgery. TTNB histology was concordant with a specific surgical histopathology in 81.9% (95% CI: 72.7-89.5; I2 = 12.1%) and with a diagnosis of a mucinous PC in 84.5% (95% CI: 70.4-94.6, I2 = 41.8%) of the cases. Using surgical histopathology as reference standard, the pooled diagnostic accuracy for histological severity of mucinous PCs was higher with TTNB vs. EUS-FNA (OR: 7.76; 95% CI: 1.21-49.9, I2 = 39%). The most common adverse event with TTNB was self-limited intracystic bleed (4.3%), followed by acute pancreatitis (1.9%) and abdominal pain (1%).

CONCLUSION:
This meta-analysis demonstrates that in the evaluation of PCs, TTNB procures a specific diagnosis and identifies a higher proportion of mucinous PCs when compared to EUS-FNA. TTNB histology is highly concordant with surgical histopathology and was more accurate in grading mucinous PCs histological severity when compared to EUS-FNA. Future comparative randomized trials are needed to corroborate these findings.
888 Percutaneous Gastrojejunostomy Tubing Utilization and Safety With Levodopa-Carbidopa Intestinal Gel in Advanced Parkinson’s Disease Patients: Interim Results of the Long-Term DUOGLOBE "Real-World" Observational Study
Authors: Draganov Peter V. , Wilcox Charles M. , Lee Michelle , Robieson Weining Z. , Kukreja Pavnit , Bergmann Lars , Peter Shajan , Symington Kenneth E. 
Published: October 2019

INTRODUCTION:
Levodopa-carbidopa intestinal gel (LCIG, carbidopa-levodopa enteral suspension [CLES] in the US) administered via percutaneous gastrojejunostomy (PEG), a jejunal (J) extension tube and an external pump is a long-term treatment option for patients with advanced Parkinson’s disease (aPD). Limited data exists on PEG-J component utilization and replacements during LCIG treatment in a ‘real-world’ setting. This interim analysis investigated the routine clinical practice of PEG-J insertion and component replacements of the device and associated safety.

METHODS:
DUOGLOBE is an ongoing multinational observational study with 3-year follow-up. This interim analysis included patients who had the PEG-J insertion procedure from 55 global sites. The type of tubing used, frequency of and reasons for tube replacements, and Serious Adverse Events (SAEs) were assessed. This analysis was not powered for statistical comparisons.

RESULTS:
This interim dataset had 188 patients with PEG-J tube placement (mean duration of PEG-J exposure: 515.8 days); 178 patients with PEG-J tubing manufacturer data were included in this analysis. At initial PEG-J tube placement, 83% (n = 148) of patients received AbbVie-proprietary tubing and 17% (n = 30) received non-AbbVie tubing. Most patients 79% (n = 141) did not require a PEG-J replacement. Patients needing any PEG-J replacement was similar between AbbVie and non-AbbVie tubing (22% and 17%); 5% of patients (n/N = 7/148) with AbbVie tubing required 2 PEG-J replacements (n/N = 0/30 for non-AbbVie tubing). In the first 12 months, Kaplan-Meier estimates demonstrated that 84% of patients did not require a tube replacement with AbbVie tubing (non-AbbVie tubing, 89%). The most common reasons for the first PEG-J replacement for AbbVie tubing was a routine, preplanned procedure (6%), PEG-J dislocation (4%), occlusion and leaking (each 2%), and other (5%); for non-AbbVie tubing PEG-J dislocation (10%) was the only reported reason. Overall, 38% of patients experienced an SAE who had AbbVie tubing (n = 56) and 47% for non-AbbVie tubing (n = 14). Gastrointestinal (GI)-related SAEs were reported in patients [n(%)] with AbbVie tubing [8(5%)] and non-AbbVie tubing [6(20%)]; 1 (1%) and 2 (7%) patients discontinued due to a GI-related AE, respectively.

CONCLUSION:
This interim analysis of patients in a multinational observational study with LCIG demonstrated that most patients did not require PEG-J tube replacements in a real-world setting and safety was similar to the known safety profile of LCIG.
890 The Impact of Multidisciplinary Evaluation Before and After Endoscopic Sleeve Gastroplasty on Weight Loss and Quality of Life
Authors: Boškoski Ivo , Bove Vincenzo , Laterza Lucrezia , Gallo Camilla , Landi Rosario , Familiari Pietro , Tringali Andrea , Perri Vincenzo , Attili Fabia , Costamagna Guido 
Published: October 2019

INTRODUCTION:
Endoscopic sleeve gastroplasty (ESG) is a relatively novel endoscopic procedure that reduces the gastric lumen with proven less complications and almost same 6 months weight loss compared to laparoscopic sleeve gastroplasty (LSG). To our knowledge there are no trials investigating the role of multidisciplinary evaluation (ME) before and after ESG. The aims of the present study were to evaluate the role of ME prior and after ESG in terms of weight loss outcomes, quality of live improvements and adverse events.

METHODS:
From May 2016 to April 2019 all patients that underwent ESG were retrospectively evaluated from a prospective database. Included patients had 2° and 3° degree of obesity or 1° with comorbidities. All patients underwent upper GI endoscopy to exclude pathologies. Until September 2017 before ESG only psychiatric evaluation was requested (group 1), while after this date we adopted the guidelines of the Italian Society for Obesity Surgery and all patients were evaluated on a multidisciplinary team composed by gastroenterologist, surgeon, psychiatrist, endocrinologist and dietitian (group 2). We compared this two groups in terms of Excess Weight Loss (%EWL), Total Body Weight Loss (%TBWL) and quality of life improvements, measured with the Bariatric Analysis and Reporting Outcome System (BAROS). ESG was done with the Apollo Overstitch suturing system (Apollo Endosurgery) and a double channel gastroscope Olympus 2TGIF-160 (Olympus Japan) in general anesthesia and with insufflation of CO2. All patients had ambulatory visit t 1, 3, 6 and 12 months after ESG. Statistical analysis was done with chi-square test and < 0.05 value was considered significant. The study was approved by the local Ethical Committee (N° 19211/18).

RESULTS:
A totally of 89 ESG were performed. Group 1 consisted of 11 patients while Group 2 of 78. Mean procedure time was 51 minutes (range 28-92). Mean number of stitches were 4.7/patient (range 3-8). No procedure related complications were observed. Female were 56 patients; mean age was 45.4 (range 23-73). Mean BMI at inclusion was 41.6 (range 31.6-62.4). Mean %EWL and %TBWL at 12 months was 37.6 and 15.6 respectively (Table 1). Comparing the two groups there was significant (P < 0.05) difference in terms of %EWL, %TBWL and BAROS scale (Table 2) for all periods of follow-up, with better results in group 2.

CONCLUSION:
ME before and after ESG has a fundamental role in terms of better procedure outcomes for both weight loss and quality of live in obese patients.
891 Efficacy and Safety of Per-Oral Cholangioscopy With Lithotripsy for Difficult Biliary Stones: A Cumulative Systematic Review and Meta-Analysis
Authors: McCarty Thomas R. , Gulati Rishabh , Rustagi Tarun 
Published: October 2019

INTRODUCTION:
Per-oral cholangioscopy with intraductal electrohydraulic lithotripsy (EHL) or laser lithotripsy facilitates optically-guided biliary stone fragmentation in cases refractory to conventional endoscopic therapy. The primary aim of this study was to evaluate the efficacy and safety of per-oral cholangioscopy with intraductal lithotripsy for difficult biliary stones.

METHODS:
Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases were performed in accordance with PRISMA and MOOSE guidelines. Measured outcomes included overall fragmentation success, single session fragmentation and duct clearance rate, and rate of adverse events. Sensitivity and subgroup analysis was performed based upon cholangioscopy technique and type of lithotripsy. Pooled rates were estimated using random effects modelswith 95% prediction interval calculated to simulate clinical practice. Heterogeneity was assessed with Cochran Q test and I
2 statistics. Publication bias was ascertained by funnel plot and Egger regression testing.

RESULTS:
Thirty-two studies (n = 1513; 43.87% male) were included. Mean age was 60.87 ± 11.83 years. Prior cholecystectomy occurred in 23% of patients with an average number of 1.56 ± 0.49 prior ERCPs performed. Mean stone size was 2.15 ± 2.8 cm. Per-oral cholangioscopy with intraductal lithotripsy achieved an overall stone fragmentation successof 91.29% (95% CI 87.78 to 93.86) with an average of 1.35 ± 0.67 lithotripsy sessions performed. Mean procedure time was 68.32 ± 20.99 minutes. Complete fragmentation success and duct clearance with a single lithotripsy session was 75.71% (95% CI 69.69 to 80.86). Rate of adverse events was 9.72% (95% CI 6.98 to 13.38). Cumulative and sensitivity analyses limited to prospective and randomized controlled trials as well as studies limited to the second generation, digital cholangioscope device are shown in Table 1. Subgroup analyses based upon EHL versus laser lithotripsy demonstrated laser therapy to be more effective – though this was not statistically significant [overall fragmentation 90.14% versus 91.79%, P = 0.384; single session success rate 70.47% versus 82.10%, P = 0.058; and adverse event rate 11.85% versus 11.30%, P = 0.810] – Table 2.

CONCLUSION:
Per-oral cholangioscopy with intraductal lithotripsy appears to be a relatively safe and highly effective modality for difficult biliary stones. Laser lithotripsy outperformed EHL treatment; however, this difference was not statistically significant.