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Cost-effectiveness of endoscopic ultrasound-guided coils plus cyanoacrylate injection compared to endoscopic cyanoacrylate injection in the management of gastric varices

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World Journal of Gastrointestinal Endoscopy 2021年第1期13卷 13-23页

作者： Carlos Robles-Medranda joao autran nebel Miguel Puga-Tejada Roberto Oleas Jorge Baquerizo-Burgos Jesenia Ospina-Arboleda Manuel Valero Hannah Pitanga-Lukashok Gastroenterology and Endoscopy Division Instituto Ecuatoriano de Enfermedades DigestivasGuayaquil 090505GuayasEcuador

BACKGROUND Cyanoacrylate(CYA)injection can be performed using a standard upper endoscopy technique or under endoscopic ultrasound(EUS)guidance alone or in combination with *** is little information available on the economic impact of these treatment *** To compare the cost-effectiveness of treating gastric varices by CYA injection via upper endoscopy vs coils plus CYA guided by *** This was an observational,descriptive,and retrospective *** were allocated into two groups:A CYA group and coils plus CYA *** baseline characteristics were compared,and a cost analysis was *** Overall,36 patients were included(19 in the CYA group and 17 in the coils+CYA group).All patients in the CYA group had acute *** underwent a higher mean number of procedures(1.47 vs 1,P=0.025),and the mean volume of glue used was 2.15 vs 1.65 mL,P=*** coils+CYA group showed a higher technical success rate(100%vs 84.2%),with a complication rate similar to the CYA *** majority of CYA patients required hospitalization,and although the mean total per procedure cost was lower(United States$1350.29 vs United States$2978),the mean total treatment cost was significantly different(United States$11060.89 for CYA vs United States$3007.13 for coils+CYA,P=0.03).CONCLUSION The use of EUS-guided coils plus cyanoacrylate is more cost-effective than cyanoacrylate injection when the total costs are ***,randomized trials are needed to validate the cost-effectiveness of the EUS-guided approach to treat gastric varices.

关键词： Cost-effectiveness Endoscopic ultrasound-guided therapy Gastric varices Gastrointestinal bleeding Hemostasis Therapy

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Endoscopic ultrasound-guided through-the-needle microforceps biopsy and needle-based confocal laser-endomicroscopy increase detection of potentially malignant pancreatic cystic lesions:A single-center study

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World Journal of Gastrointestinal Endoscopy 2022年第3期14卷 129-141页

作者： Carlos Robles-Medranda Juan I Olmos Miguel Puga-Tejada Roberto Oleas Jorge Baquerizo-Burgos Martha Arevalo-Mora Raquel Del Valle Zavala joao autran nebel Daniel Calle Loffredo Hannah Pitanga-Lukashok Gastroenterology and Endoscopy Division Instituto Ecuatoriano de Enfermedades DigestivasGuayaquil 090505Ecuador

BACKGROUND Currently,there is insufficient data about the accuracy in the diagnosing of pancreatic cystic lesions(PCLs),especially with novel endoscopic techniques such as with direct intracystic micro-forceps biopsy(mFB)and needle-based confocal laser-endomicroscopy(nCLE).AIM To compare the accuracy of endoscopic ultrasound(EUS)and associated techniques for the detection of potentially malignant PCLs:EUS-guided fine needle aspiration(EUS-FNA),contrast-enhanced EUS(CE-EUS),EUS-guided fiberoptic probe cystoscopy(cystoscopy),mFB,and *** This was a single-center,retrospective *** identified patients who had undergone EUS,with or without additional diagnostic techniques,and had been diagnosed with *** determined agreement among malignancy after 24-mo follow-up findings with detection of potentially malignant PCLs via the EUSguided techniques and/or EUS-guided biopsy when available(EUS malignancy detection).RESULTS A total of 129 patients were included, with EUS performed alone in 47/129. In 82/129 patients,EUS procedures were performed with additional EUS-FNA (21/82), CE-EUS (20/82), cystoscopy(27/82), mFB (36/82), nCLE (44/82). Agreement between EUS malignancy detection and the 24-mo follow-up findings was higher when associated with additional diagnostic techniques thanEUS alone [62/82 (75.6%) vs 8/47 (17%);OR 4.35, 95%CI: 2.70-7.37;P < 0.001]. The highestmalignancy detection accuracy was reached when nCLE and direct intracystic mFB were bothperformed, with a sensitivity, specificity, positive predictive value, negative predictive value andobserved agreement of 100%, 89.4%, 77.8%, 100% and 92.3%, respectively (P < 0.001 comparedwith EUS-alone).CONCLUSIONThe combined use of EUS-guided mFB and nCLE improves detection of potentially malignantPCLs compared with EUS-alone, EUS-FNA, CE-EUS or cystoscopy.

关键词： Pancreatic cysts Endoscopic ultrasound-guided fine-needle aspiration Confocal microscopy Image-guided biopsy

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