bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and tolerability of colonoscopies in overweight and obese patients: Results from a national database on gastrointestinal endoscopic outcomes
Authors: Passi Monica , Rahman Farial , Koh Christopher , Kumar Sheila 
Published: April 2022

AbstractBackground and study aims Gastroenterologists are encountering a rising number of obese patients requiring colonoscopy. Existing literature regarding colonoscopy outcomes in this population is scant and conflicting. We analyzed a nationwide cohort of patients to identify the effects of body mass index (BMI) on colonoscopy success, efficacy, and tolerability.Patients and methods The Clinical Outcomes Research Initiative (CORI) endoscopic database was queried for all colonoscopies in adults between 2008–2014. Patients were stratified into four cohorts based on BMI classification for comparison. Multivariable analysis was performed to identify the effect of BMI on procedure outcome, efficacy and tolerability.Results Of 41,401 procedures, 27,696 met study inclusion criteria. Of these, 49.4 % were performed for colorectal cancer screening, most commonly under anesthesia directed sedation. Patient discomfort was the reason for an incomplete colonoscopy in 18.7 % of all cases, and more frequent among the overweight and obese cohorts. An inadequate bowel preparation was most common in the class III obesity cohort. Compared to the normal BMI group, a BMI ≥ 30 and < 40 kg/m2 was associated with an increased odds of an incomplete colonoscopy (P = 0.001for overweight, P = 0.0004 for class I/II obesity), longer procedure (P < 0.05 for all) and poorer tolerance (P < 0.0001 for class I/II obesity, P = 0.016 for class III obesity). Anesthesia-administered sedation was more commonly used than endoscopist directed sedation amongst the obese cohort compared with the normal BMI cohort (P < 0.0001).Conclusions Endoscopists should consider the increased odds of incomplete colonoscopy, longer procedures, and poorer tolerance when performing colonoscopy in obese patients to improve clinical management and procedural outcome.
Impact of ≥ 0.1-mm free resection margins on local intramural residual cancer after local excision of T1 colorectal cancer
Authors: ter Borg Frank , Moons Leon M.G. , Gijsbers Kim M. , van der Schee Lisa , van Veen Tessa , van Berkel Annemarie M. , Boersma Femke , Bronkhorst Carolien M. , Didden Paul D. , Haasnoot Krijn J.C. , Jonker Anne M. , Kessels Koen , Knijn Nikki , van Lijnschoten Ineke , Mijnals Clinton , Milne Anya N. , Moll Freek C.P. , Schrauwen Ruud W.M. , Schreuder Ramon-Michel , Seerden Tom J. , Spanier Marcel B.W.M. , Terhaar Sive Droste Jochim S. , Witteveen Emma , de Vos tot Nederveen Cappel Wouter H. , Vleggaar Frank P. , Laclé Miangela M. ,   Dutch T1 CRC Working Group
Published: April 2022

Abstract
Background and study aims A free resection margin (FRM) > 1 mm after local excision of a T1 colorectal cancer (CRC) is known to be associated with a low risk of local intramural residual cancer (LIRC). The risk is unclear, however, for FRMs between 0.1 to 1 mm. This study evaluated the risk of LIRC after local excision of T1 CRC with FRMs between 0.1 and 1 mm in the absence of lymphovascular invasion (LVI), poor differentiation and high-grade tumor budding (Bd2–3).
Patients and methods Data from all consecutive patients with local excision of T1 CRC between 2014 and 2017 were collected from 11 hospitals. Patients with a FRM ≥ 0.1 mm without LVI and poor differentiation were included. The main outcome was risk of LIRC (composite of residual cancer in the local excision scar in adjuvant resection specimens or local recurrence during follow-up). Tumor budding was also assessed for cases with a FRM between 0.1 and 1mm.
Results A total of 171 patients with a FRM between 0.1 and 1 mm and 351 patients with a FRM > 1 mm were included. LIRC occurred in five patients (2.9 %; 95 % confidence interval [CI] 1.0–6.7 %) and two patients (0.6 %; 95 % CI 0.1–2.1 %), respectively. Assessment of tumor budding showed Bd2–3 in 80 % of cases with LIRC and in 16 % of control cases. Accordingly, in patients with a FRM between 0.1 and 1 mm without Bd2–3, LIRC was detected in one patient (0.8%; 95 % CI 0.1–4.4 %).
Conclusions In this study, risks of LIRC were comparable for FRMs between 0.1 and 1 mm and > 1 mm in the absence of other histological risk factors.
Efficacy of remimazolam versus midazolam for procedural sedation: post hoc integrated analyses of three phase 3 clinical trials
Authors: Schippers Frank , Stöhr Thomas , Dao Van-Anh 
Published: April 2022

Abstract
Background and study aims Remimazolam is an ultra-short acting, fast onset/fast offset benzodiazepine for intravenous use in procedural sedation, general anesthesia, and Intensive Care Unit sedation. The aim of this work was to compare the efficacy of remimazolam versus midazolam dosed according to medical practice (real-world midazolam) and midazolam dosed according to US prescribing information (on-label midazolam) for procedural sedation.
Patients and methods This post hoc analysis was performed using integrated data from three randomized, placebo, and active (midazolam) controlled, phase 3 clinical trials in patients undergoing colonoscopy and bronchoscopy. Statistical comparisons between treatment groups, without adjustment for potential confounding factors, were exploratory and observational in nature.
Results The mean ± SD dose of midazolam in the real-world midazolam group was 6.2 ± 3.1 mg, compared with 3.5 ± 1.5 mg in the on-label midazolam group. remimazolam showed significantly shorter time from first dose to start of procedure (median 3 minutes) compared to on-label midazolam (median 8 minutes). Recovery time from end of procedure to fully alert was significantly shorter for remimazolam (median 6 minutes) than real-world midazolam (median 14 minutes), enabling earlier transfer of patients from the procedure room to the recovery area with a lower requirement for patient monitoring. The onset and recovery times with remimazolam showed significantly less inter-patient variability than with on-label midazolam and real-world midazolam, respectively. Patients treated with remimazolam received significantly less fentanyl for analgesia (78.2 ± 28.4 µg) than did those treated with real-world midazolam (113.6 ± 60.1 µg) and on-label midazolam (92.5 ± 40.0 µg).
Conclusions Remimazolam offers advantages over midazolam in terms of faster recovery and less fentanyl requirement, which may facilitate increased procedural throughput in clinical practice.
Using fecal immunochemical test values below conventional cut-off to individualize colorectal cancer screening
Authors: Plantener Eva , Deding Ulrik , Madsen Jeppe Buur , Kroijer Rasmus , Madsen Jonna Skov , Baatrup Gunnar 
Published: April 2022

Abstract
Background and study aims Of the participants in the Danish screening program, 89.9 % to 92.5 % have fecal immunochemical test (FIT) values < 10 μg/g feces (equivalent to 50 ng hemoglobin/mL buffer). This study aimed to investigate the risk of interval colorectal cancer (CRC) in this group before the next biennial screening round.
Patients and methods This cohort study included all citizens from the region of Southern Denmark who participated in the Danish bowel screening program from 2014 trough 2016 and had a FIT value < 10 μg/g feces. Individuals receiving a CRC diagnosis were identified through the national CRC registry, with a follow up of 2 years corresponding to the current screening interval. We also examined the 3-year CRC incidence. Hazard ratios (HRs) were estimated using univariate and multivariate Cox proportional hazard regression models.
Results Data from 185,654 citizens presenting with a FIT value < 10 μg/g feces were eligible for analysis. Overall, interval CRC incidence was 0.07 % within 2 years with HRs of 4.16 (95 % confidence interval [CI] 2.67;6.48) and 5.8 (95 % CI 3.34;10.05) for FIT values of 4 to 6.9 μg/g feces and 7 to 9.9 μg/g feces, respectively, compared to those having a FIT value below the limit of quantification of 4 μg/g feces. After 3 years, the overall CRC incidence increased to 0.14 %; however, this was not significant.
Conclusions This study demonstrates a positive correlation between FIT value and risk of interval cancer even for very low values. It further suggests that an increase in the screening interval could be reasonable in the low FIT categories.
Komplette Okklusion der Arteria radialis durch einen kardiogenen Embolus bei infektiöser Endokarditis
Authors: Bugariu Marios , Tilkorn Daniel , Hauser Joerg , Bienek Markus 
Published: April 2022

ZusammenfassungWir präsentieren den Fall einer septischen Thrombosierung der rechtsseitigen Arteria radialis durch einen kardiogenen Embolus auf Grundlager einer infektiösen Endokarditis. Nach initialem Verdacht einer beugeseitigen Unterarmphlegmone bei bestehender Tenosynovitis zeigte sich intraoperativ eine langstreckige Thrombosierung der Arteria radialis. Wir führten die Resektion des thrombosierten Gefäßabschnittes sowie die Rekonstruktion mittels Veneninterponat durch. Im Rahmen der Fokussuche fanden sich echokardiografisch Vegetationen am vorderen Mitralklappensegel. Im Zuge dessen erfolgte die operative Mitralklappensegelrekonstruktion mittels Mitralklappenanuloplastik.
Lipoabdominoplastik in der postbariatrischen Chirurgie: eine relevante Alternative zur Fleur-de-Lis-Abdominoplastik?
Authors: Motamedi Melodi , Almeida Jessica , Allert Sixtus 
Published: April 2022

Zusammenfassung
Hintergrund Die Anzahl an bariatrischen Operationen und somit auch die Anzahl an postbariatrischen Eingriffen ist in den letzten Jahren dramatisch gestiegen. Obwohl in der postbariatrischen Chirurgie lange Narbenverläufe zu Gunsten einer Körperformrekonstruktion üblich sind, beobachten wir neben dem Wunsch der Körperkonturierung zunehmend den nach ästhetisch ansprechenderen Ergebnissen. Insbesondere die Fleur-de-Lis-Abdominoplastik wird aufgrund der sichtbaren vertikalen Narbe von jungen Patientinnen nach massivem Gewichtsverlust kritisch gesehen. Häufig stören sich auch Operateure sowohl am ästhetischen Outcome wie auch an der höheren Komplikationsrate.
Methoden Retrospektive Analyse von 20 Patientinnen nach massivem Gewichtsverlust nach bariatrischer Operation, die im Zeitraum von Januar 2020 bis Januar 2021 statt einer Fleur-de-Lis Abdominoplastik eine Lipoabdominoplastik erhalten haben. Die Datenanalyse erfolgte anhand des präoperativen vertikalen und horizontalen Hautüberschüsse (Pittsburgh Rating Scale), anhand des Body-Mass-Index, der operativen Technik und des Endresultats.
Ergebnisse 20 Patientinnen mit einer Indikation zur Durchführung einer FdL-Abdominoplastik unterzogen sich einer kombinierten radikalen Liposuktion des Bauches mit traditioneller Abdominoplastik. Das Ursprungsgewicht vor der massiven Gewichtsreduktion rangierte zwischen 100–168 kg. Die durchschnittliche Gewichtsreduktion lag bei 56,5 kg. Im Mittel betrug der BMI 27,3 kg/m². Das Durchschnittsalter unserer Studiengruppe betrug 40 Jahre. Bei einer Patientin (5 %) konnte eine Major-Komplikation verzeichnet werden. Es handelte sich um ein infiziertes Serom, welches konservativ behandelt werden konnte. Eine Patientin (5 %) wünschte eine Nachstraffung in FDL-Technik im weiteren Verlauf.
Fazit Die Durchführung einer Lipoabdominoplastik ist auch bei postbariatrischen Patienten gut und sicher durchführbar. Es zeigen sich gute Körperkonturierungen ohne vertikale Schnittführung mit einem hohen Maß an Patientenzufriedenheit. Die Anzahl an Patienten, die sich einer FdL-Abdominoplastik unterziehen müssten, kann mit dieser Technik erfolgreich gesenkt werden.
Direct percutaneous endoscopic jejunostomy (DPEJ) and percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) technical success and outcomes: Systematic review and meta-analysis
Authors: Deliwala Smit S. , Chandan Saurabh , Kumar Anand , Mohan Babu , Ponnapalli Anoosha , Hussain Murtaza S. , Kaushal Sunil , Novak Joshua , Chawla Saurabh 
Published: April 2022

Abstract
Background and study aims Endoscopic methods of delivering uninterrupted feeding to the jejunum include direct percutaneous endoscopic jejunostomy (DPEJ) or PEG with jejunal extension (PEG-J), validated from small individual studies. We aim to perform a meta-analysis to assess their effectiveness and safety in a variety of clinical scenarios.
Methods Major databases were searched until June 2021. Efficacy outcomes included technical and clinical success, while safety outcomes included adverse events (AEs) and malfunction rates. We assessed heterogeneity using I2
and classic fail-safe to assess bias.
Results 29 studies included 1874 patients (983 males and 809 females); mean age of 60 ± 19 years. Pooled technical and clinical success rates with DPEJ were 86.6 % (CI, 82.1–90.1, I2
73.1) and 96.9 % (CI, 95.0–98.0, I2
12.7). The pooled incidence of malfunction, major and minor AEs with DPEJ were 11 %, 5 %, and 15 %. Pooled technical and clinical success for PEG-J were 94.4 % (CI, 85.5–97.9, I2
33) and 98.7 % (CI, 95.5–99.6, I2
< 0.001). The pooled incidence of malfunction, major and minor AEs with DPEJ were 24 %, 1 %, and 25 %. Device-assisted DPEJ performed better in altered gastrointestinal anatomy. First and second attempts were 87.6 % and 90.2 %.
Conclusions DPEJ and PEG-J are safe and effective procedures placed with high fidelity with comparable outcomes. DPEJ was associated with fewer tube malfunction and failure rates; however, it is technically more complex and not standardized, while PEG-J had higher placement rates. The use of balloon enteroscopy was found to enhance DPEJ performance.
Endoscopic diagnosis of gastric intestinal metaplasia in patients with autoimmune gastritis using narrow-band imaging: does pseudopyloric metaplasia muddy the waters?
Authors: Dilaghi Emanuele , Esposito Gianluca , Pivetta Giulia , Galli Gloria , Pilozzi Emanuela , Annibale Bruno , Lahner Edith 
Published: April 2022

Abstract
Background and study aims In autoimmune atrophic gastritis (AAG), associated with intestinal (IM) and/or pseudopyloric metaplasia (PPM), endoscopic surveillance is recommended for gastric cancer risk mainly linked to IM. Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) reliably identifies IM, but has not been assessed in AAG. We aimed to assess the performance of EGGIM (index test) versus histology (reference test) of corpus IM in AAG.
Patients and methods This was a cross-sectional study of 210 AAG patients undergoing surveillance gastroscopy with narrow-band imaging (NBI): corpus IM scored according to EGGIM, histology according to updated Sydney system, and morphological criteria.
Results NBI identified corpus IM in 88.6 % of AAG patients: EGGIM were 0, 1, 2, 3, 4 in 11.4 %, 0.5 %, 33.3 %, 1.9 %, and 52.9 %, respectively. Histology identified corpus IM in 78.1 % and PPM in 79.5 % of patients. PPM was present with IM in 57.6 % and without IM in 21.9 % patients, 20.5 % had IM without PPM. EGGIM, compared to histology, correctly classified 76.2 % of patients, showing high sensitivity (91.5 %, 95 %CI 86.1–95.3). EGGIM correctly classified 93 % of patients with IM without PPM, 90.9 % with both metaplasias, and 21.7 % with PPM without IM yielding low specificity (21.7 %, 95 %CI 10.9–36.4).
Conclusions In AAG, EGGIM showed high accuracy and sensitivity identifying > 90 % of patients with histological corpus IM. EGGIM overestimated IM when PPM without IM was present, yielding low specificity. These findings raise the question of whether in AAG, PPM and IM may display similar endoscopic features on NBI.
Safety and efficacy of dual emission endoscopic laser treatment in patients with upper or lower gastrointestinal vascular lesions causing chronic anemia: results from the first multicenter cohort study
Authors: Tontini Gian Eugenio , Dioscoridi Lorenzo , Rimondi Alessandro , Cantù Paolo , Cavallaro Flaminia , Giannetti Aurora , Elli Luca , Pastorelli Luca , Pugliese Francesco , Mutignani Massimiliano , Vecchi Maurizio 
Published: April 2022

Abstract
Objectives and study aims Recent pilot studies have assessed the feasibility of a novel 1.9-/1.5-μm dual emission endoscopic laser treatment (1.9-/1.5-μmDEELT) for endoscopic hemostasis, ablation and resection. In this study, we investigated the safety and efficacy of 1.9-/1.5-μmDEELT in patients with chronic anemia due to gastrointestinal vascular lesions in a real-life multicenter cohort setting.
Patients and methods Consecutive patients with moderate/severe iron-deficiency anemia undergoing 1.9-/1.5-μmDEELT for upper and lower gastrointestinal bleeding due to vascular lesions were enrolled in three academic referral centers. Safety and successful ablation of vascular lesions were the primary outcomes. Long-term hemoglobin level, blood transfusion requirements, endoscopic severity scores of complex vascular disorders and technical lasing parameters were also assessed. Long-term hemoglobin variations have been further assessed, with repeated measure analysis of variance and univariate analyses.
Results Fifty patients (median age 74; range 47 to 91 years) with gastric antral vascular ectasia (GAVE) (22), angioectasia (22) and radiation proctopathy (6) underwent 58 1.9-/1.5-μmDEELT between 2016 and 2020. All procedures were technically feasible leading to successful ablation of the targeted lesion/s, with no incident or adverse event potentially related to the 1.9-/1.5-μmDEELT technique. Within a 6-month follow-up, hemoglobin values significantly rose (+ 1.77 at 1 month and + 1.70 g/dL at 6 months, P < 0.01), the blood supply requirement decreased (at least one transfusion in 32 versus 13 patients, P < 0.01), and GAVE lesions showed a clear endoscopic improvement (from 5 points to 1 points, P < 0.01).
Conclusions The 1.9-/1.5-μm laser system is a safe and effective endoscopic tool for haemostatic ablation of bleeding vascular lesions within the gastrointestinal tract in tertiary referral centers.
Endoscopic or surgical treatment for necrotizing pancreatitis: Comprehensive systematic review and meta-analysis
Authors: Mohamadnejad Mehdi , Anushiravani Amir , Kasaeian Amir , Sorouri Majid , Djalalinia Shirin , Kazemzadeh Houjaghan Amirmasoud , Gaidhane Monica , Kahaleh Michel 
Published: April 2022

Abstract
Background and study aims Treatment of necrotizing pancreatitis is changed over the past two decades with the availability of endoscopic, and minimally invasive surgical approaches. The aim of this systematic review was to assess outcomes of endoscopic drainage, and different types of surgical drainage approaches in necrotizing pancreatitis.
Methods Medline, Embase, Scopus, and Web of Science were searched from 1998 to 2020 to assess outcomes in endoscopic drainage and various surgical drainage procedures. The assessed variables consisted of mortality, development of pancreatic or enteric fistula, new onset diabetes mellitus, and exocrine pancreatic insufficiency.
Results One hundred seventy studies comprising 11,807 patients were included in the final analysis. The pooled mortality rate was 22 % (95 % confidence interval [CI]: 19%–26 %) in the open surgery (OS), 8 % (95 %CI:5 %–11 %) in minimally invasive surgery (MIS), 13 % (95 %CI: 9 %–18 %) in step-up approach, and 3 % (95 %CI:2 %–4 %) in the endoscopic drainage (ED). The pooled rate of fistula formation was 35 % (95 %CI:28 %–41 %) in the OS, 17 % (95 %CI: 12%–23 %) in MIS, 17 % (95 %CI: 9 %–27 %) in step-up approach, and 2 % (95 %CI: 0 %–4 %) in ED. There were 17 comparative studies comparing various surgical drainage methods with ED. The mortality rate was significantly lower in ED compared to OS (risk ratio [RR]: 30; 95 %CI: 0.20–0.45), and compared to MIS (RR: 0.40; 95 %CI: 0.26–0.6). Also, the rate of fistula formation was lower in ED compared to all other surgical drainage approaches.
Conclusions This systematic review demonstrated lower rate of fistula formation with ED compared to various surgical drainage methods. A lower rate of mortality with ED was also observed in observational studies. PROSPERO Identifier: CRD42020139354
Endoscopic stenting for malignant biliary obstruction is technically successful in patients with preexisting duodenal stents
Authors: Simoes Priya K. , Schattner Mark A. , Gerdes Hans , Shah Pari M. , Kurtz Robert C. , Mendelsohn Robin B. 
Published: April 2022

Abstract
Background and study aims There are limited data on the success of endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant biliary and duodenal obstruction with a preexisting duodenal stent. The aim of this study was to evaluate patient and procedural outcomes of a cohort of patients with preexisting duodenal stents who underwent an attempt at ERCP for malignant biliary obstruction (MBO).
Patients and methods This was a single-center retrospective study on consecutive patients with a preexisting duodenal stent who underwent attempted ERCP for MBO. Technical success was defined as successful cannulation of the common bile duct, with successful dilation and/or deployment of a biliary stent under fluoroscopy. Clinical success was defined as number of patients in the entire group who underwent ERCP successfully with resolution of symptoms.
Results We identified 64 patients (73 % men, 74 % white, median age 62 years) with a preexisting duodenal stent who underwent 85 attempts at ERCP. ERCP was technically successful in 50 of 85 procedures (59 %). Overall ERCP was successful in 41 of 85 patients (48 %). ERCP was more likely to be successful in patients with Type 1 and 3 duodenal strictures than with Type 2 strictures (83 % and 92 % vs. 42 %, P < 0.01), in patients with a preexisting sphincterotomy (79% vs. 20 %, P = 0.01) or preexisting biliary stent (66 % vs. 34 %, P = 0.04). Adverse events included bleeding (n = 3), post-procedure fever (n = 3) and abdominal pain (n = 1).
Conclusions Although biliary stenting via ERCP is often technically challenging in patients with a prior duodenal stent, it is a safe and effective method of biliary drainage. ERCP should be attempted in patients with Type 1 and 3 duodenal strictures, a prior sphincterotomy or an indwelling biliary stent.