scholarly journals Fibrin-Specific Thrombolytic Therapy for Acute CVA within 6 Hours of Onset, Systematic Review and Meta-analysis

2020 ◽  
Vol 7 (1) ◽  
pp. 16-22
Author(s):  
Abdullah Alreesi ◽  
Amal Al Mandhari ◽  
Marwan Al Raisi ◽  
Huda Al Ruqaishi ◽  
Fahad Al Abri ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Thrombolytic Therapy ◽  
Functional Outcome ◽  
Therapy Group ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Central Register ◽  
Intracerebral Bleeding

Objective: Cerebrovascular Accident (CVA) remains a major cause of disability and death and fibrinolytic agents might reduce long-term disability. We sought to determine whether patients receiving fibrin-specific thrombolytic agents acutely (within 6 h) following CVA had improved functional outcome, or decreased mortality or increased intracerebral bleeding at 6-months than patients receiving placebo. Materials and Methods: We conducted a systematic review of randomized controlled clinical trials that assessed 6-months functional outcome, mortality and intracranial hemorrhage and compared thrombolytic therapy with placebo in patients randomized within the first 6 hours following CVA. We searched these databases: MEDLINE (1990-2018), Cochrane Central Register of Controlled Trials, and Cochrane Database for Systematic Reviews. Two blinded reviewers reviewed the eligible articles and rated study quality using the Jadad score. We calculated pooled Odds Ratios (ORs) using a random effect model. Results: We included 9 studies with 6523 enrolled participants and had 673 deaths. Compared with placebo, thrombolytic therapy within 6 hours of CVA did not result in a statistically significant reduction in 6-month mortality (OR 1.21, 95% confidence interval [CI] 0.94–1.55). More patients in the thrombolytic therapy group had favorable functional outcome (OR 1.20 confidence interval [CI] 1.07–1.35). Thrombolytic therapy caused more fatal intracerebral bleeding than placebo (OR 5.61 confidence interval [CI] 3.40-9.24). Conclusion: Fibrin-Specific thrombolytic within 6 hours of CVA improves functional outcome at the expense of increasing symptomatic and fatal intracerebral bleed. Future studies are required before extending the thrombolytic window to 6-hours.

scholarly journals SPORTS AND PERFORMANCE IN THE TRANSGENDER POPULATION: A SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Vol 27 (6) ◽  
pp. 637-645
Author(s):  
Roberto Lohn Nahon ◽  
Ana Paula Simões da Silva ◽  
Renan Muniz-Santos ◽  
Rayanne Carneiro Torres de Novaes ◽  
Laura Souza Prado Lobrigati Pedroso
Keyword(s):  
Systematic Review ◽  
Muscle Strength ◽  
Confidence Interval ◽  
Hormone Therapy ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Sex Hormone ◽  
Strength Analysis ◽  
Estimate Effect

ABSTRACT Introduction: The debate surrounding the regulations on the participation of transgender individuals in sports is not recent, but it is still ongoing. Some sports organizations are more flexible in this regard, while others are more conservative. Objective: Through a systematic review and meta-analysis, this study summarizes the scientific evidence of the effects of cross-sex hormone therapy on muscle strength, hematocrit, and hemoglobin measurements, parameters that seem to be linked to sports performance. Methods: We conducted electronic searches for manuscripts published before November 20th, 2020. Studies published in three different databases (PubMed, SciELO, and Lilacs) were included, without any time or language restriction, and using keywords such as “transgender”, “gender dysphoria”, “strength”, “hematocrit”, and “hemoglobin”. The PRISMA systematization was used for the elaboration of this review, while a meta-analysis was conducted to mathematically evidence the results. The meta-analysis was performed using the random effect model, to find the pooled estimate effect of cross-sex hormone therapy on the parameters analyzed. Results: The electronic search retrieved 21 articles that were eligible for inclusion. Cross-sex hormone therapy influenced the three parameters analyzed in almost all the studies. Overall, there was a significant increase in muscle strength in female-to-males (FtMs), per muscle group analyzed: +17.7% (95% confidence interval [CI]14.9;20.6). In male-to-females (MtFs) the results of the muscle strength analysis were more controversial, but the pooled estimate effect showed a decrease: −3.6% (95% confidence interval [CI] −6.6; −0.6). Conclusion: Muscle strength, hematocrit, and hemoglobin were altered as a result of cross-sex hormone therapy in both FtMs and MtFs. However, there was a lack of studies comparing the transgender individuals to the population of the same desired gender. Such studies are needed, to better infer rules for the participation of transgender athletes in Olympic sports. Level of Evidence I; Systematic Review and Meta-analysis.

scholarly journals Oxygen Therapy in Headache Disorders: A Systematic Review

2021 ◽  
Vol 11 (3) ◽  
pp. 379
Author(s):  
Tiziana Ciarambino ◽  
Gennaro Sansone ◽  
Giovanni Menna ◽  
Ombretta Para ◽  
Giuseppe Signoriello ◽  
...  
Keyword(s):  
Systematic Review ◽  
Oxygen Therapy ◽  
Therapy Group ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Placebo Treatment ◽  
High Flow ◽  
Headache Disorders ◽  
High Flow Oxygen

Background: The global active prevalence of migraines is approximately 14.7%. Oxygen therapy may reduce the use of non-steroidal anti-inflammatory drugs (NSAIDs) which often have various negative side effects. The purpose of this systematic review is to analyze the literature on the efficacy of high flow oxygen for the management of headache disorders, compared to placebo treatment. Methods: Studies were identified by PubMed, Web of Science and Scopus database from 1980 to the 30 October 2020. The search included the following terms: “oxygen therapy” and “headache” and “migraine”. Studies were included if high flow oxygen was used in the treatment of headache disorders. All selected studies were qualitatively analyzed. Results: Our literature search identified 71 studies, of which 65 were discarded and 6 were included in the meta-analysis. The random effect model did not show a pooled significant resolution of headache disorders (OR 2.08 (95% CI 0.92–4.70), p < 0.0001) in the oxygen therapy group compared to the placebo group. Conclusion: In our systematic review of six studies, there were no significant differences between high flow oxygen and placebo treatment groups.

Chlamydia pneumoniae and Mycoplasma pneumoniae as two Emerging Risk Factors in Atherosclerosis: Meta-Analysis Study and Systematic Review

2021 ◽  
Vol 21 ◽  
Author(s):  
Mahsa Jalili ◽  
Hassan Nourmohammadi ◽  
Kourosh Sayehmiri
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Confidence Interval ◽  
Bacterial Infection ◽  
Chlamydia Pneumoniae ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Analysis Study ◽  
Persian Language

Background: Previous studies suggested an association between Chlamydia pneumoniae and Mycoplasma pneumonia with atherosclerosis, separately. Until now, according to inconsistent information, the relationship between C.pneumoniae and M.pneumoniae with atherosclerosis is controversial. Objective: The aim of this study, investigate of the association between C.pneumoniae and M.pneumoniae as two separate risk factors with atherosclerosis by systematic review and meta-analysis study. Methods: We searched databases such as Pubmed, SID, Magiran, Google scholar and Iranmedex using the following keywords in English and Persian language as C. pneumoniae , M. pneumoniae and atherosclerosis. Data were analyzed with meta-analysis and a random effect model. Also, in this study Heterogeneity of articles were estimated by using I2 index. Finally, data was analyzed with STAT (version 11.2) Results: Among thirty-eight articles for C. pneumoniae and five articles for M. pneumoniae individually reviewed that included 2980 samples for M. pneumoniae and 23298 samples for C. pneumoniae, result demonstrated that association between M. pneumoniae and C. pneumoniae with atherosclerosis is significant with OR (odd ratio) = 1.58 (95% Confidence Interval (CI): 1.00 to 2.50), OR (odd ratio) = 2.25(95% Confidence Interval (CI): 1.91 to 2.64), respectively. Conclusion: This systematic review study provides strong evidence for the role of persistent bacterial infection such as M. pneumoniae and C. pneumoniae in potential atherosclerosis. Thus, a novel way should be employed for the complete management of bacterial infection.

scholarly journals Dundee Ready Educational Environment Measure Tool for Evaluating the Educational Environment: A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (F) ◽  
pp. 108-116
Author(s):  
Faraz Ahmed Farooqi ◽  
Soban Qadir Khan ◽  
Abdul Khabeer ◽  
Saqib Ali ◽  
Asim Al-Ansari
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Educational Environment ◽  
Significant Heterogeneity ◽  
Medical College ◽  
Positive Side ◽  
Group 2

OBJECTIVE: The purpose of this systematic review was to study the literature evaluating the educational environment by using DREEM tool and compute overall mean DREEM score by using Meta-analysis. Further, variation in DREEM score was also studied by distributing studies into different time periods. MATERIALS AND METHODS: A systematic literature search was performed using PubMed and Web of Science databases, followed by review and analysis. All the studies which used DREEM as a tool, published from 1997 to December 2015 were included. Heterogeneity between the studies was assessed by I2-coefficient and Q-statistics. Where significant heterogeneity existed random effect, model was used. Egger’s symmetric test and Begg’s funnel plot was used to study possibility of publication bias. The PRISMA Guideline for systematics review was used. RESULTS: Out of 128 published DREEM studies, 43 passed the criteria and included in analysis. Overall mean DREEM score through Meta-analysis was 2.426 (95% confidence interval [CI]: 2.34-2.52). Studies were divided into two groups for analyzing the time effect. Mean score of the studies published during 1997 to 2009 (group 1) was 2.5 (95% confidence interval [CI]: 2.35-2.64) and for the studies from 2010 to 2015 (group 2) was 2.39 (95% confidence interval [CI]: 2.29-2.5). CONCLUSION: Overall DREEM score was more towards positive side than negative. Current review revealed that DREEM has not been used as predictor for achievement of any medical college instead it can be used to predict high and low achievers in a medical school. This review can signify DREEM to be suitable and consistent tool showing learning environment of institute and student’s prerequisites.

scholarly journals The Clinical Efficacy and Adverse Effects of Entecavir plus Thymosin alpha-1 Combination Therapy versus Entecavir Monotherapy in HBV-related Cirrhosis: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Dan Peng ◽  
Hai-Yan Xing ◽  
Chen Li ◽  
Xian-Feng Wang ◽  
Min Hou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Large Sample Size ◽  
Significant Heterogeneity ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Thymosin Alpha 1

Abstract Background Previous studies have demonstrated the benefits of thymosin alpha-1 (Tα1) in anti-virus, immunological enhancement and anti-inflammation. However, it is controversial about the efficacy and safety of entecavir (ETV) plus Tα1 combination therapy versus ETV monotherapy in cirrhosis patients with hepatitis B virus (HBV) infection. Objective The systematic review and meta-analysis of randomized clincal trials (RCTs) were performed to evaluate the efficacy and safety of ETV plus Tα1 compared with ETV monotherapy in HBV-related cirrhosis. Methods A systematic search was performed via PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Journals Database (VIP), and Chinese Biological Medicine database (CBM). Relative risk (RR) and standardized mean difference (SMD) with a fixed- or random- effect model were calculated. Heterogeneity were assessed with the Cochrane Q-test and I 2 values. Results Seven RCTs involving 1144 subjects were included in the systematic review and meta-analysis. Compared with ETV monotherapy, ETV plus Tα1 combination therapy led to a higher complete response (RR = 1.18; 95% CI, 1.07 - 1.30). The HBV DNA undetectable rate and HBeAg loss rate of ETV plus Tα1 therapy for 24 weeks was higher than the ETV alone (RR = 1.91; 95% CI, 1.56 - 2.35; RR = 2.05; 95% CI, 1.62 - 2.60). However, after treatment for 48 and 52 weeks, there was no significantly different between the combination therapy and ETV monotherapy (RR = 1.07; 95% CI, 0.96 - 1.18; RR = 1.17; 95% CI, 0.89 - 1.55). In comparison with ETV alone, ETV plus Tα1 improved part of biochemical parameters and liver fibrosis. There was significant heterogeneity. In addition, The ETV plus Tα1 significantly reduced adverse events compared to ETV monotherapy (RR = 0.48; 95% CI, 0.24 - 0.95). Conclusions ETV plus Tα1 combination therapy might have a higher clinical response and a lower comprehensive adverse reaction rate in HBV-related cirrhosis patients compared with ETV monotherapy. Meanwhile, the whole patients included in this meta-analysis were from chinese mainland, so that more worldwide RCTs with a large sample size are needed to verify the current findings.

scholarly journals Alteration of Postural Balance in Patients with Fibromyalgia Syndrome—A Systematic Review and Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 127
Author(s):  
David Núñez-Fuentes ◽  
Esteban Obrero-Gaitán ◽  
Noelia Zagalaz-Anula ◽  
Alfonso Javier Ibáñez-Vera ◽  
Alexander Achalandabaso-Ochoa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postural Balance ◽  
Fibromyalgia Syndrome ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Healthy Controls ◽  
Functional Balance ◽  
Sensory Organization ◽  
Effect Model

Balance problems are one of the most frequent symptoms in patients with Fibromyalgia Syndrome (FMS). However, the extent and nature of this balance disorder are not known. The objective of this work was to determine the best evidence for the alteration of postural balance in patients with FMS and analyze differences with healthy controls. To meet this objective, a systematic review with meta-analysis was performed. A bibliographical search was carried out in PubMed Medline, Scopus, Web of Science, CINAHL and SciELO. Observational studies that assessed postural balance in patients with FMS compared to healthy subjects in baseline conditions, were selected. In a random-effect model, the pooled effect was calculated with the Standardized Mean Difference (SMD) and its 95% confidence interval (CI). Nineteen studies reporting data of 2347 participants (95% female) were included. FMS patients showed poor balance with a large effect on static (SMD = 1.578; 95% CI = 1.164, 1.992), dynamic (SMD = 0.946; 95% CI = 0.598, 1.294), functional balance (SMD = 1.138; 95% CI = 0.689, 1.588) and on balance confidence (SMD = 1.194; 95% CI = 0.914, 1.473). Analysis of the Sensory Organization Test showed large alteration of vestibular (SMD = 1.631; 95% CI = 0.467, 2.795) and visual scores (SMD = 1.317; 95% CI = 0.153, 2.481) compared to healthy controls. Patients with FMS showed worse scores for different measures of postural balance compared to healthy controls. Concretely, FMS patients appear to have poor vestibular and visual scores with a possible somatosensory dependence.

scholarly journals Magnitude and determinants of neural tube defect in Africa: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Atlaw ◽  
Yohannes Tekalegn ◽  
Biniyam Sahiledengle ◽  
Kenbon Seyoum ◽  
Damtew Solomon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Neural Tube ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Folic Acid Supplementation ◽  
Maternal Exposure ◽  
X Ray ◽  
Effect Model ◽  
Pooled Prevalence

Abstract Background Neural tube defects (NTDs) are a group of disorders that arise from the failure of the neural tube close between 21 and 28 days after conception. About 90% of neural tube defects and 95% of death due to these defects occurs in low-income countries. Since these NTDs cause considerable morbidity and mortality, this study aimed to determine the prevalence and associated factors of NTDs in Africa. Methods The protocol of this study was registered in the International Prospective Register of Systematic Reviews (PROSPERO number: CRD42020149356). All major databases such as PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, African Journals Online (AJOL), and Google Scholar search engine were systematically searched. A random-effect model was used to estimate the pooled prevalence of NTDs in Africa, and Cochran’s Q-statistics and I2 tests were used to assess heterogeneity between included studies. Publication bias was assessed using Begg ’s tests, and the association between determinant factors and NTDs was estimated using a random-effect model. Results Of the total 2679 articles, 37 articles fulfilled the inclusion criteria and were included in this systematic review and meta-analysis. The pooled prevalence of NTDs in Africa was 50.71 per 10,000 births (95% CI: 48.03, 53.44). Folic acid supplementation (AOR: 0.40; 95% CI: 0.19–0.85), maternal exposure to pesticide (AOR: 3.29; 95% CI: 1.04–10.39), mothers with a previous history of stillbirth (AOR: 3.35, 95% CI: 1.99–5.65) and maternal exposure to x-ray radiation (AOR 2.34; 95% CI: 1.27–4.31) were found to be determinants of NTDs. Conclusions The pooled prevalence of NTDs in Africa was found to be high. Maternal exposure to pesticides and x-ray radiation were significantly associated with NTDs. Folic acid supplementation before and within the first month of pregnancy was found to be a protective factor for NTDs.

scholarly journals Statins to mitigate cardiotoxicity in cancer patients treated with anthracyclines and/or trastuzumab: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Mary Obasi ◽  
Arielle Abovich ◽  
Jacqueline B. Vo ◽  
Yawen Gao ◽  
Stefania I. Papatheodorou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Weighted Mean ◽  
Ventricular Ejection Fraction

Abstract Purpose Cardiotoxicity affects 5–16% of cancer patients who receive anthracyclines and/or trastuzumab. Limited research has examined interventions to mitigate cardiotoxicity. We examined the role of statins in mitigating cardiotoxicity by performing a systematic review and meta-analysis of published studies. Methods A literature search was conducted using PubMed, Embase, Web of Science, ClinicalTrials.gov, and Cochrane Central. A random-effect model was used to assess summary relative risks (RR), weighted mean differences (WMD), and corresponding 95% confidence intervals. Testing for heterogeneity between the studies was performed using Cochran’s Q test and the I2 test. Results Two randomized controlled trials (RCTs) with a total of 117 patients and four observational cohort studies with a total of 813 patients contributed to the analysis. Pooled results indicate significant mitigation of cardiotoxicity after anthracycline and/or trastuzumab exposure among statin users in cohort studies [RR = 0.46, 95% CI (0.27–0.78), p = 0.004, $${ }I^{2}$$ I 2  = 0.0%] and a non-significant decrease in cardiotoxicity risk among statin users in RCTs [RR = 0.49, 95% CI (0.17–1.45), p = 0.20, $$I^{2}$$ I 2  = 5.6%]. Those who used statins were also significantly more likely to maintain left ventricular ejection fraction compared to baseline after anthracycline and/or trastuzumab therapy in both cohort studies [weighted mean difference (WMD) = 6.14%, 95% CI (2.75–9.52), p < 0.001, $$I^{2}$$ I 2  = 74.7%] and RCTs [WMD = 6.25%, 95% CI (0.82–11.68, p = 0.024, $$I^{2}$$ I 2  = 80.9%]. We were unable to explore publication bias due to the small number of studies. Conclusion This meta-analysis suggests that there is an association between statin use and decreased risk of cardiotoxicity after anthracycline and/or trastuzumab exposure. Larger well-conducted RCTs are needed to determine whether statins decrease risk of cardiotoxicity from anthracyclines and/or trastuzumab. Trial Registration Number and Date of Registration PROSPERO: CRD42020140352 on 7/6/2020.

scholarly journals Association between Oral Contraceptives and cutaneous melanoma: a systematic review and metanalysis

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
I Giacchetta ◽  
M Chiavarini ◽  
G Naldini ◽  
R Fabiani
Keyword(s):  
Systematic Review ◽  
Malignant Melanoma ◽  
Publication Bias ◽  
Oral Contraceptives ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cutaneous Malignant Melanoma ◽  
Hormonal Factors ◽  
Increased Risk

Abstract Background The probability of developing invasive cutaneous malignant melanoma (CMM) is higher in women than in men up until the age of 49. Several studies investigated the association between hormonal factors and CMM. The aim of this systematic review and meta-analysis is to summarize the evidence on the association between Oral Contraceptives (OC) and the risk of CMM. Methods This review and meta-analysis follow the PRISMA guidelines. A systematic literature search was conducted on Medline and Web of Science until December 2019. Studies were eligible if reported a risk estimate for the association between OC and CMM. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by Egger's test and Begg's test. Meta-analysis was performed using random effect model. Results The results of the pooled analysis of all 32 studies showed no significant association between OC and the risk of CMM (OR 1.02; 95% CI 0.94-1.11; I2=39.32%, p = 0.013). The stratified analyses by study design found no significant association between OC and the risk of CMM neither in the 18 case-control studies (OR 1.02; 95% CI 0.87-1.21; I2=56.91%, p = 0.002) nor in the 14 cohort studies (OR 1.04; 95% CI 0.98-1.11; I2=0.00%, p = 0.557). No significant publication bias could be detected by Egger's test or Begg's test. Conclusions This meta-analysis of available literature suggests no significant association between OC and the risk of developing CMM. Further investigations are needed to evaluate the possible relationship of OC use and other hormonal factors potentially contributing to the increased risk of CMM in women during their reproductive years. Key messages Oral contraceptives (OC) do not significantly contribute to the risk of Cutaneous Malignant Melanoma (CMM). Further studies are needed to investigate the potential role of other hormonal factors in the increased probability of developing CMM in women during their reproductive years.

scholarly journals Is Routine Preoperative Esophagogastroduodenoscopy Prior to Bariatric Surgery Mandatory? Systematic Review and Meta-analysis of 10,685 Patients

2020 ◽  
Vol 30 (8) ◽  
pp. 3073-3083 ◽  
Author(s):  
Walid El Ansari ◽  
Ayman El-Menyar ◽  
Brijesh Sathian ◽  
Hassan Al-Thani ◽  
Mohammed Al-Kuwari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bariatric Surgery ◽  
Publication Bias ◽  
Surgical Approach ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background This systematic review and meta-analysis searched, retrieved and synthesized the evidence as to whether preoperative esophagogastroduodenoscopy (p-EGD) should be routine before bariatric surgery (BS). Methods Databases searched for retrospective, prospective, and randomized (RCT) or quasi-RCT studies (01 January 2000–30 April 2019) of outcomes of routine p-EGD before BS. STROBE checklist assessed the quality of the studies. P-EGD findings were categorized: Group 0 (no abnormal findings); Group 1 (abnormal findings that do not necessitate changing the surgical approach or postponing surgery); Group 2 (abnormal findings that change the surgical approach or postpone surgery); and Group 3 (findings that signify absolute contraindications to surgery). We assessed data heterogeneity and publication bias. Random effect model was used. Results Twenty-five eligible studies were included (10,685 patients). Studies were heterogeneous, and there was publication bias. Group 0 comprised 5424 patients (56%, 95% CI: 45–67%); Group 1, 2064 patients (26%, 95% CI: 23–50%); Group 2, 1351 patients (16%, 95% CI: 11–21%); and Group 3 included 31 patients (0.4%, 95% CI: 0–1%). Conclusion For 82% of patients, routine p-EGD did not change surgical plan/ postpone surgery. For 16% of patients, p-EGD findings necessitated changing the surgical approach/ postponing surgery, but the proportion of postponements due to medical treatment of H Pylori as opposed to “necessary” substantial change in surgical approach is unclear. For 0.4% patients, p-EGD findings signified absolute contraindication to surgery. These findings invite a revisit to whether p-EGD should be routine before BS, and whether it is judicious to expose many obese patients to an invasive procedure that has potential risk and insufficient evidence of effectiveness. Further justification is required.

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