scholarly journals Endoscopic ultrasound-guided gallbladder drainage versus percutaneous cholecystostomy for high risk surgical patients with acute cholecystitis: a systematic review and meta-analysis

Endoscopy ◽  
2019 ◽  
Vol 51 (08) ◽  
pp. 722-732 ◽  
Author(s):  
Sally Wai-Yin Luk ◽  
Shayan Irani ◽  
Rajesh Krishnamoorthi ◽  
James Yun Wong Lau ◽  
Enders Kwok Wai Ng ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Acute Cholecystitis ◽  
Clinical Success ◽  
Meta Analysis ◽  
Surgical Patients ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Post Procedure ◽  
Hospital Stays

Abstract Background Recent evidence suggests that endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) is an effective and safe alternative to percutaneous drainage (PT-GBD). We conducted a systematic review and meta-analysis to compare these two procedures in high risk surgical patients with acute cholecystitis. Methods A comprehensive electronic literature search was conducted for all articles published up to October 2017 to identify comparative studies between EUS-GBD and PT-GBD. A meta-analysis was performed on outcomes including technical success, clinical success, post-procedure adverse events, length of hospital stay, unplanned hospital readmission, need for reintervention, recurrent cholecystitis, and disease- or treatment-related mortality for these two procedures. Results Five comparative studies (206 patients in the EUS-GBD group vs. 289 patients in the PT-GBD group), were included in the final analysis. There were no statistically significant differences in technical success (odds ratio [OR] 0.43, 95 % confidence interval [CI] 0.12 to 1.58; P  = 0.21; I 2 = 0 %) and clinical success (OR 1.07, 95 %CI 0.36 to 3.16; P  = 0.90; I 2 = 44 %) between the two procedures. EUS-GBD had fewer adverse events than PT-GBD (OR 0.43, 95 %CI 0.18 to 1.00; P  = 0.05; I 2 = 66 %). Moreover, patients undergoing EUS-GBD had shorter hospital stays, with pooled standard mean difference of – 2.53 (95 %CI – 4.28 to – 0.78; P = 0.005; I 2 = 98 %), and required significantly fewer reinterventions (OR 0.16, 95 %CI 0.04 to 0.042; P <  0.001; I 2 = 32 %) resulting in significantly fewer unplanned readmissions (OR 0.16, 95 %CI 0.05 to 0.53; P  = 0.003; I 2 = 79 %). Conclusions EUS-GBD was associated with lower rates of post-procedure adverse events, shorter hospital stays, and fewer reinterventions and readmissions compared with PT-GBD in patients with acute cholecystitis who were unfit for surgery.

Efficacy and safety of lumen apposing metal stents or self-expandable metal stents for endoscopic ultrasound-guided choledocho-duodenostomy: a systematic review and meta-analysis

Endoscopy ◽  
2020 ◽  
Author(s):  
Arnaldo Amato ◽  
Emanuele Sinagra ◽  
Ciro Celsa ◽  
Marco Enea ◽  
Andrea Buda ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Primary Outcome ◽  
Clinical Success ◽  
Meta Analysis ◽  
Metal Stents ◽  
Efficacy And Safety ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Post Procedure

BACKGROUND Endoscopic ultrasound (EUS)-guided biliary drainage is becoming an option for palliation of malignant biliary obstruction. Lumen apposing metal stents (LAMS) are replacing self-expandable metal stents (SEMS). Aim of this meta-analysis was to evaluate the efficacy and safety of LAMS or SEMS for EUS-guided choledocho-duodenostomy. METHODS A meta-analysis was performed using PRISMA protocols. Electronic databases were searched for studies on EUS-guided choledocho-duodenostomy. The primary outcome was the clinical success. Technical success, re-intervention and adverse events were secondary outcomes. We used the random effects model with the DerSimonian-Laird estimation and the results were depicted using the forest plots. Furthermore, we performed analysis of the outcomes with the data stratified by selected variables. RESULTS Overall, 31 studies (820 patients) were included. The pooled rates of clinical and technical success were 93.6% (95% CI [95%CI] 88.6-96.5%) and 94.8% (95%CI 90.2-97.3%), for LAMS , and 91.7% (95%CI 88.1-94.2) and 92.7 % (95%CI 89.9-94.9%) for SEMS, respectively. The pooled rates of adverse events were 17.1% (95%CI 12.5-22.8%) for LAMS compared to 18.3% (95% CI 14.3-23.0%) for SEMS. The pooled rates of re-intervention were 10.9% (95% CI 7.7-15.3%) for LAMS compared to 13.9% (95% CI 9.6-19.7%) for SEMS. Subgroup analyses confirmed these results. CONCLUSIONS This meta-analysis shows that LAMS and SEMS are comparable in terms of efficacy for EUS-guided choledocho-duodenostomy. The use of LAMS was associated with similar clinical and technical success, post-procedure adverse events and re-intervention rate when compared with SEMS placement. These last two points require further investigation.

scholarly journals Efficacy and safety of endoscopic ultrasound-guided pancreatic duct drainage (EUS-PDD): A systematic review and meta-analysis of 714 patients

2020 ◽  
Vol 08 (11) ◽  
pp. E1664-E1672
Author(s):  
Saurabh Chandan ◽  
Babu P. Mohan ◽  
Shahab R. Khan ◽  
Lena L. Kassab ◽  
Suresh Ponnada ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pancreatic Duct ◽  
Endoscopic Ultrasound ◽  
Clinical Success ◽  
Meta Analysis ◽  
Fluid Collection ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Anastomotic Strictures ◽  
Pancreatic Duct Drainage

Abstract Background and study aims Endoscopic ultrasound guided pancreatic duct drainage (EUS-PDD) is a minimal-invasive therapeutic option to surgery and in patients with failed endoscopic retrograde pancreatography (ERP). The aim of this review was to quantitatively appraise the clinical outcomes of EUS-PDD by meta-analysis methods. Methods We searched multiple databases from inception through March 2020 to identify studies that reported on EUS-PDD. Pooled rates of technical success, successful drainage of pancreatic duct, clinical success, and adverse events were calculated. Study heterogeneity was assessed using I2% and 95 % prediction interval. Results A total of 22 studies (714 patients) were included. The pooled rate of technical success in EUS-PDD was 84.8 % (95 % CI 79.1–89.2). The pooled rate of successful PD drained by EUS-PDD was 77.5 % (95 % CI 63.1–87.4). The pooled rate of clinical success of EUS-PDD was 89.2 % (95 % CI 82.1–93.7). The pooled rate of all adverse events was 18.1 % (95 % CI 14.2–22.9). On sub-group analysis, the pooled technical success and clinical success of EUS-PDD from Japanese data were considerably superior (91.2 %, 83–95.6 & 92.5 %, 83.9–96.7, respectively). The pooled rate of post EUS-PDD acute pancreatitis was 6.6 % (95 % CI 4.5–9.4), bleeding was 4.1 % (95 % CI 2.7–6.2), perforation and/or pneumoperitoneum was 3.1 % (95 % CI 1.9–5), pancreatic leak and/or pancreatic fluid collection was 2.3 % (95 % CI 1.4–4), and infection was 2.8 % (95 % CI 1.7–4.6). Conclusion EUS-PDD demonstrates high technical success and clinical success rates with acceptable adverse events. Technical success was especially high for anastomotic strictures.

Clinical outcomes and efficacy of endoscopic ultrasound guided ablation of pancreatic cancer a systematic review and a meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16261-e16261
Author(s):  
Hamid Ehsan ◽  
Muhammad Nadeem Yousaf ◽  
Ahsan Wahab ◽  
Karun Neupane ◽  
Muhammad Khawar Sana ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Cancer ◽  
Clinical Outcome ◽  
Success Rate ◽  
Clinical Success ◽  
Meta Analysis ◽  
Clinical Success Rate ◽  
Unresectable Pancreatic Cancer ◽  
Technical Success ◽  
Ultrasound Guided

e16261 Background: Endoscopic ultrasound-guided ablation therapy (EUS-A) is a minimally invasive technique increasingly used for the management of surgically unresectable pancreatic cancer. The data on the efficacy and clinical outcome of EUS-A for unresectable pancreatic cancer is lacking. We conducted this systematic review and meta-analysis to evaluate the safety, technical and clinical success of EUS-A therapies specifically for unresectable pancreatic cancer. Methods: Studies were identified with a comprehensive search for EUS-A and pancreatic cancer on PubMed, Google Scholar, Web of Science and Embase data search as of October 2020. The technical and clinical success rates of EUS-A were primary outcomes while adverse events (AEs) rate was secondary outcome. We defined technical success as successful placement of probe within tumor and able to perform ablation regardless of tumor outcome. Clinical success was defined as symptomatic improvement and/or any reduction in tumor size or evidence of necrosis on radiological imaging after EUS-A. A compute pooled analysis was performed using the ‘meta’ package by Schwarzer et al. in the R programming language (version 4.0.2) using random effect model. Results: Nineteen studies including 192 patients (54% females) were included. Common pancreatic tumors were nonfunctional neuroendocrine tumor (NNET) 43.5% (97), followed by locally advanced pancreatic ductal adenocarcinoma (LAPDAC) 27.3% (61), insulinoma 17.9% (40), cystic neoplastic lesions 8.5% (19). The pancreatic head was the most common site of tumor 49.8% (111), followed by body, neck and tail 44.8% (100). EUS-RFA was the most commonly used ablative therapy 63% (12/19 studies), followed by EUS-EA (ethanol ablation) 26% (5/19 studies) while EUS-A using laser and lauromacrogol injection was used in one study each. The mean number of ablation sessions per patient was 1.4 based on the total 243 sessions in 176 patients. The pooled technical success rate of EUS-A was 99.5% [95% CI = 0.90-0.97, I2 = 0%]. The pooled clinical success rate calculated out of total number of pancreatic lesions was 91.1% [95% CI = 0.79-0.92, I2 = 16%]. Clinical improvement in symptoms was reported in 11 studies and a complete resolution or decrease in tumor size was reported in 16 studies. The pooled AEs rate was 22.9% [95% CI = 0.17-0.37, I2 = 43%]. Common AEs were abdominal pain 7.8% (15), pancreatitis 5.2% (10) and pancreatic pseudocyst 2.1% (4). The median follow-up was 9.5 months. Conclusions: EUS-A is a safe and promising modality in the management of unresectable pancreatic cancer with a high technical and clinical success rate. Large prospective studies and clinical trials are required for comparison of clinical outcome of different EUS-A therapies and its widespread application for unresectable pancreatic cancer.

scholarly journals Endoscopic ultrasound-guided choledochoduodenostomy using partially-covered self-expandable metal stent in patients with malignant distal biliary obstruction and unsuccessful ERCP

2018 ◽  
Vol 06 (01) ◽  
pp. E67-E72 ◽  
Author(s):  
Praveer Rai ◽  
CR Lokesh ◽  
Amit Goel ◽  
Rakesh Aggarwal
Keyword(s):  
Adverse Events ◽  
Biliary Drainage ◽  
Biliary Obstruction ◽  
Patency Rate ◽  
Clinical Success ◽  
Metal Stent ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Stent Patency ◽  
Post Procedure

Abstract Background and study aims Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) is an alternative to percutaneous transhepatic biliary drainage (PTBD) for patients with malignant distal biliary obstruction in whom ERCP has failed. We studied technical success, clinical success, stent patency rate and occurrence of adverse events in patients undergoing EUS-CDS with partially-covered self-expanding metal stent (PCSEMS). Patients and methods Medical records of consecutive patients with unresectable malignant distal biliary obstruction requiring biliary drainage who underwent EUS-CDS because of failure of attempt at ERCP were reviewed. EUS-CDS was done using 6-cm, PCSEMS (Wallflex, Boston Scientific). Technical success, clinical success (more than 50 % reduction in total bilirubin at 2 weeks post-procedure), stent patency rate and adverse events (AEs) were assessed. Patients were followed up for 3 months post-procedure. Results Between January 2015 and December 2016, 30 patients underwent EUS-CDS, including 20 (67 %) with failed biliary cannulation and 10 (33 %) with duodenal stenosis. Technical success was achieved in 28 patients, all of whom also had clinical success. Median total serum bilirubin decreased from 20 mg/dL to 5 mg/dL at 2 weeks post-procedure. Three patients (10 %) had adverse events (bile leak, hemobilia, stent block in one patient each; no stent migration); none of these adverse events was major and all were managed successfully. There were no procedure-related deaths. Five patients died of disease progression in the 3-month period post-procedure, and the 3-month dysfunction-free stent patency rate was 83 %. Conclusion EUS-CDS with a PCSEMS has a high technical and clinical success. Adverse events were infrequent, minor and could be managed easily.

scholarly journals Endo-sponge in management of anastomotic colorectal leaks: a systematic review and meta-analysis

2021 ◽  
Vol 09 (09) ◽  
pp. E1342-E1349
Author(s):  
Banreet S. Dhindsa ◽  
Yassin Naga ◽  
Syed M. Saghir ◽  
Sarav Gunjit Singh Daid ◽  
Saurabh Chandan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Colorectal Surgery ◽  
Adverse Events ◽  
Clinical Success ◽  
Meta Analysis ◽  
Anastomotic Dehiscence ◽  
Vacuum Therapy ◽  
Success Rates ◽  
Technical Success ◽  
Generalized Peritonitis

Abstract Background and study aims Following colorectal surgery, anastomotic dehiscence and leak formation has an incidence of 2 % to 7 %. Endo-SPONGE has been applied in the management of anastomatic leaks (ALs) after colorectal surgery. This is the first systematic review and meta analysis to evaluate the efficacy and safety of Endo-SPONGE in the management of colorectal ALs. Patients and methods The primary outcomes assessed were the technical and clinical success of Endo-SPONGE placement in colorectal ALs. The secondary outcomes assessed were the overall adverse events (AEs) and the AE subtypes. Pooled estimates were calculated using random-effects models with 95 % confidence interval (C. I.). The statistical analysis was done using STATA v16.1 software (StataCorp, LLC College Station, Texas, United States). Results The analysis included 17 independent cohort studies with a total of 384 patients. The rate of technical success was 99.86 % (95 % CI: 99.2 %, 100 %; P = 0.00; I2  = 70.69 %) and the calculated pooled rate of clinical success was 84.99 % (95 % CI: 77.4 %, 91.41 %; P = 0.00; I2  = 68.02 %). The calculated pooled rate of adverse events was 7.6 % (95 % CI: 3.99 %, 12.21 %; P = 0.03; I2  = 42.5 %) with recurrent abscess formation and bleeding being the most common AEs. Moderate to substantial heterogeneity was noted in our meta-analysis. Conclusions Endoscopic vacuum therapy appears to be a minimally invasive, safe, and effective treatment modality for patients with a significant colorectal leak without any generalized peritonitis with high clinical and technical success rates and a low rate of adverse events. Further prospective or randomized controlled trials are needed to validate our findings.

Efficacy and safety of over-the-scope clips for gastrointestinal bleeding: a systematic review and meta-analysis

Endoscopy ◽  
2019 ◽  
Vol 51 (10) ◽  
pp. 941-949 ◽  
Author(s):  
Viveksandeep Thoguluva Chandrasekar ◽  
Madhav Desai ◽  
Muhammad Aziz ◽  
Harsh K. Patel ◽  
Venkata Subhash Gorrepati ◽  
...  
Keyword(s):  
Systematic Review ◽  
Large Scale ◽  
Clinical Success ◽  
Meta Analysis ◽  
Clinical Success Rate ◽  
Line Treatment ◽  
Gi Bleeding ◽  
Technical Success ◽  
Primary Hemostasis

Background The over-the-scope clip (OTSC) has been increasingly utilized for the management of gastrointestinal (GI) bleeding. Limited efficacy data are currently available from large-scale studies. Methods An electronic database search was conducted for eligible articles using OTSCs for hemostasis in GI bleeding. The primary outcome was the rate of definitive hemostasis after primary hemostasis and without rebleeding at follow-up. Secondary outcomes were: primary technical success, primary clinical success, rebleeding, and failure rates. Pooled rates were expressed as proportions of patients with events over total patients, 95 % confidence limits (CI) with heterogeneity, and P values of < 0.05 for significance. Results A total of 21 studies (n = 851) were analyzed (62.2 % males), with a median patient age of 69.7 years. The definitive hemostasis rate was 87.8 % (95 %CI 83.7 % – 92 %) after a median follow-up of 56 days. The OTSC was successfully deployed in 97.8 % of patients (95 %CI 96.7 % – 98.9 %) and the primary clinical success rate was 96.6 % (95 %CI 95.1 % – 98.2 %). Rebleeding was seen in 10.3 % of patients (95 %CI 6.5 % – 14.1 %). The failure rate of OTSCs was 9 % (95 %CI 5.2 % – 12.8 %) when used as first-line treatment and 26 % (95 %CI 16.1 % – 36.0 %) when used as second-line treatment. Conclusion This systematic review showed high rates of definitive hemostasis, technical success, and clinical success, along with low rebleeding rates when OTSCs were used for the treatment of GI bleeding. The lack of randomized controlled trials of OTSC vs. other therapies makes comparison with conventional treatment difficult.

scholarly journals Optimal Treatment for Complicated Intra-abdominal Infections in the Era of Antibiotic Resistance: A Systematic Review and Meta-Analysis of the Efficacy and Safety of Combined Therapy With Metronidazole

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Hiroshige Mikamo ◽  
Akira Yuasa ◽  
Keiko Wada ◽  
Bruce Crawford ◽  
Naomi Sugimoto
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Clinical Success ◽  
Combined Therapy ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Combination Therapies ◽  
Bacteriological Eradication ◽  
All Cause Mortality ◽  
Abdominal Infections

Abstract Background.  Carbapenem-resistant Enterobacteriaceae has increased dramatically in the last decade, resulting in infections that are difficult to treat and associated with high mortality rates. To prevent further antibacterial resistance, it is necessary to use carbapenem selectively. A combination of metronidazole with an antimicrobial agent active against aerobes is an alternative effective treatment for patients with complicated intra-abdominal infections (cIAIs). This study aimed to compare efficacy and safety of metronidazole combination therapies and carbapenem and to provide clinical evidence regarding the optimal treatment of cIAI. Methods.  A systematic review and a meta-analysis of randomized clinical trials in the treatment of cIAI were conducted. The systematic review with PubMed, Embase, and the Cochrane Database of Systematic Reviews followed the Cochrane Handbook's recommended methodology, and the meta-analysis used a Mantel-Haenszel random-effects model with RevMan, version 5.3. Primary endpoints were clinical success and bacteriological eradication, and secondary endpoints were all-cause mortality and drug-related adverse events. Results.  Eight studies comparing metronidazole combination therapies and carbapenem were included in the meta-analysis. No difference was found between combined therapy with metronidazole and carbapenem regarding clinical success (odds ratio [OR] = 1.31; 95% confidence interval [CI], .75–2.31), bacteriological eradication (OR = 1.27; 95% CI, .84–1.91), all-cause mortality (OR = 0.61; 95% CI, .37–1.00), or drug-related adverse events (OR = 0.58; 95% CI, .18–1.88). Sensitivity analyses found similar results. Conclusions.  Combined therapy with metronidazole is as effective and safe as carbapenem in treatment of cIAI. Therefore, combined therapy with metronidazole offers an effective alternative to carbapenem with low risk of drug resistance.

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