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.

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.

Vacuum Therapy and Internal Drainage as the First-Line Endoscopic Treatment for Post-Bariatric Leaks: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-8
Author(s):  
Issaree Laopeamthong ◽  
Thanita Akethanin ◽  
Wisit Kasetsermwiriya ◽  
Suphakarn Techapongsatorn ◽  
Amarit Tansawet
Keyword(s):  
Systematic Review ◽  
Fixed Effects ◽  
Primary Outcome ◽  
Clinical Success ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Data Availability ◽  
Vacuum Therapy ◽  
Internal Drainage ◽  
First Line

<b><i>Introduction:</i></b> Several endoscopic methods can be employed to manage post-bariatric leaks. However, endoluminal vacuum therapy (EVT) and endoscopic internal drainage (EID) are relatively new methods, and studies regarding these methods are scarce. We performed a systematic review of the literature and a meta-analysis to evaluate the efficacy of EVT and EID. <b><i>Methods:</i></b> Databases were searched for eligible studies. The clinical success of leak closure was the primary outcome of interest. A proportional meta-analysis was performed for pooling the primary outcome using a fixed-effects model. A meta-analysis or descriptive analysis of other outcomes was performed based on the data availability. <b><i>Results:</i></b> Data from 3 EVT and 10 EID studies (<i>n</i> = 279) were used for evidence synthesis. The leak closure rates (95% confidence interval [CI]) of EVT and EID were 85.2% (75.1%–95.4%) and 91.6% (88.1%–95.2%), respectively. The corresponding mean treatment durations (95% CI) were 28 (2.4–53.6) and 78.4 (50.1–106.7) days, respectively. However, data about other outcomes were extremely limited; thus, a pooled analysis could not be performed. <b><i>Conclusions:</i></b> Both EVT and EID were effective when used as the first-line treatment for post-bariatric leaks. However, larger studies must be conducted to compare the efficacy of the 2 interventions.

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.

scholarly journals Endoscopic biliary self-expandable metallic stent in malignant biliary obstruction with or without sphincterotomy: systematic review and meta-analysis

2019 ◽  
Vol 07 (01) ◽  
pp. E26-E35 ◽  
Author(s):  
Benedetto Mangiavillano ◽  
Amedeo Montale ◽  
Leonardo Frazzoni ◽  
Mario Bianchetti ◽  
Amrita Sethi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Success Rate ◽  
Meta Analysis ◽  
Stent Insertion ◽  
Metallic Stent ◽  
Success Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Expandable Metallic Stent ◽  
Increased Risk

Abstract Background and aim To assess the rate of adverse events and the technical success rate of biliary stenting with or without EBS.  Methods A literature search up to February 2017 was performed. Studies assessing adverse events (AEs) and technical success rates of stenting with or without EBS were considered. Results Seven studies (870 patients; 12 treatment arms) were included. Early AEs, i. e. those occurring within 30 days, were significantly lower in no-EBS vs. EBS-group (11 % vs. 20.1 %; OR: 0.36, 95 %CI: 0.13 – 1.00). Rates of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis were not significantly different in the two groups (no-EBS vs. EBS: 6.1 % vs 5 %; OR: 1.33, 95 %CI: 0.68 – 2.59). The rate of bleeding was significantly lower in patients without EBS (no-EBS vs EBS: 0 % vs 5 %; OR: 0.12, 95 % CI: 0.03 – 0.45). Rates of cholangitis were significantly lower in patients without EBS (no-EBS vs. EBS: 3.3 % vs. 7.4 %; OR: 0.38, 95 %CI: 0.17 – 0.83). Both late AEs and mortality rates did not significantly differ between no-EBS and EBS patients (19.9 % vs. 18.9 %; OR: 0.93, 95 %CI: 0.56 – 1.53, and 2.5 % vs. 2.9 %; OR: 1.18, 95 %CI: 0.22 – 6.29, respectively). The technical success rate for stent insertion also did not differ (98 % vs. 97.6 %; OR: 1.05, 95 %CI: 0.42 – 2.63). Conclusion EBS seems to be associated, in the first 30 days after the procedure, with an increased risk of cholangitis and bleeding. No difference was observed in the rate of post-ERCP pancreatitis.

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.

The Effect of Peroral Endoscopic Myotomy in Achalasia Patients with Prior Endoscopic Intervention: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-13
Author(s):  
Chunyu Zhong ◽  
Bowen Ni ◽  
Sixiu Liu ◽  
Shali Tan ◽  
Muhan Lü ◽  
...  
Keyword(s):  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Clinical Success ◽  
Meta Analysis ◽  
Clinical Success Rate ◽  
Peroral Endoscopic Myotomy ◽  
Technical Success ◽  
Endoscopic Intervention ◽  
Eckardt Score ◽  
Endoscopic Myotomy

<b><i>Background:</i></b> Peroral endoscopic myotomy (POEM) has been reported to be effective in achalasia patients with prior failed endoscopic intervention (PFI). We performed this meta-analysis to compare and summarize the clinical outcome of POEM in patients with or without prior endoscopic intervention. <b><i>Method:</i></b> We searched relevant studies published up to March 2020. Meta-analysis for technical success, clinical success, Eckardt score, lower esophageal sphincter (LES) pressure, clinical reflux, and adverse event were conducted based on a random-effects model. <b><i>Results:</i></b> Eight studies enrolling 1,797 patients who underwent POEM were enrolled, including 1,128 naïve achalasia patients and 669 patients with PFI. In the PFI group, the pooled estimated rate of technical success was 97.7% (95% confidence interval [CI], 95.8–98.8%), the pooled clinical success rate was 91.0% (95% CI, 88.0–93.4%), and the pooled adverse events rate was 23.5% (95% CI, 10.6–44.1%). The Eckardt score significantly decreased by 5.95 points (95% CI, 5.50–6.40, <i>p</i> &#x3c; 0.00001) and the LES pressure significantly reduced by 19.74 mm Hg (95% CI, 14.10–25.39, <i>p</i> &#x3c; 0.00001) in the PFI group. There were no difference in the technical success, clinical success, and adverse events rate between the treatment-naïve group and PFI group, with a risk ratio of 1.0 (95% CI, 0.99–1.01, <i>p</i> = 0.89), 1.02 (95% CI, 0.98–1.06, <i>p</i> = 0.36), and 0.88 (95% CI, 0.67–1.16, <i>p</i> = 0.38), respectively. <b><i>Conclusions:</i></b> POEM is an effective and safe treatment for achalasia patients with prior endoscopic intervention. Randomized clinical trials are needed to further verify the efficiency and safety of the POEM in those patients.

scholarly journals Efficacy and Safety of EUS-Guided Choledochoduodenostomy Using Electrocautery-Enhanced Lumen-Apposing Metal Stents (ECE-LAMS) in the Treatment of Biliary Obstruction: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zuxiang Peng ◽  
Shan Li ◽  
Yongliang Tang ◽  
Wanjie Wei ◽  
Ruxian Pi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Biliary Obstruction ◽  
Clinical Success ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Metal Stents ◽  
Efficacy And Safety ◽  
Short Term

Background. Electrocautery-enhanced lumen-apposing metal stents (ECE-LAMS) have been newly developed to perform EUS-guided choledochoduodenostomy (EUS-CDS), but its benefits and harms remain obscure. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of EUS-CDS using ECE-LAMS. Method. In the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we searched PubMed, Embase, and Scopus databases through January 1, 2001, and April 27, 2020. The primary outcomes of the pooled analysis were to determine the technical success, clinical success, and overall adverse events rates. The secondary outcomes were pooled rates of short-term and long-term adverse events. Results. Six studies with 270 patients were finally included in this meta-analysis. The pooled rates of technical, clinical success, and adverse events were 95.1% (95% CI = 90.6–97.5%, I2 = 25%), 93.3% (95% CI = 87.4–96.5%, I2 = 28%), and 15.3% (95% CI = 10.6–21.6%, I2 = 13%), respectively. The pooled rates of short-term and long-term adverse events were 3.6% (95% CI = 1.3–9.6%, I2 = 0%) and 11.3% (95% CI = 7.6–16.5%, I2 = 0%), respectively. Conclusion. EUS-CDS using ECE-LAMS provides favorable outcomes in patients with biliary obstruction. It has been associated with a higher success rate and a lower rate of adverse events when compared with the biliary drainage approaches previously used. Large and randomized controlled observational studies are required to further refine the findings in the present analysis.

scholarly journals Role of peroral endoscopic myotomy in geriatric patients with achalasia: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Chunyu Zhong ◽  
Sixiu Liu ◽  
Huifang Xia ◽  
Shali Tan ◽  
Muhan Lü ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Geriatric Patients ◽  
Clinical Success ◽  
Meta Analysis ◽  
Peroral Endoscopic Myotomy ◽  
Cochrane Library ◽  
Eckardt Score ◽  
Endoscopic Myotomy

Background: Peroral endoscopic myotomy (POEM) is a particularly attractive intervention for achalasia. Presently, POEM has been reported to be effective and safe for achalasia in geriatric patients. Herein, this systematic review was conducted to explore the role of POEM in geriatric patients with achalasia. Method: PubMed, Embase and Cochrane Library were searched to identify studies evaluating the clinical outcome of POEM in geriatric patients with achalasia during January 2009 to October 2020. The primary outcomes were technical and clinical success. Secondary outcomes included postoperative Eckardt score, lower esophageal sphincter (LES) pressure, adverse events and clinical reflux. Results: There were seven studies with a total of 469 geriatric patients, pooled technical success of POEM treatment was 98.1% [95% confidence interval (CI), 95.1%-99.3%], and the pooled clinical success was 92.5% (95% CI, 89.3%-94.8%). After POEM, the Eckardt score significantly decreased by 6.09 points (95% CI, 5.44-6.74, P<0.00001), and the LES pressure significantly reduced by 13.53 mmHg (95% CI, 5.14-21.91, P=0.002). The pooled adverse events rate was 9.0% (95% CI, 4.3%-17.9%) and the post-POEM clinical reflux rate was 17.4% (95% CI, 12.9%-23.2%). Conclusions: Our current study demonstrated that POEM was an effective and safe technique for achalasia in geriatric patients.

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