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Bravo (wireless) ambulatory esophageal pH monitoring: How do day 1 and day 2 results compare?

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World Journal of Gastroenterology 2007年第30期13卷 4091-4095页

作者： matthew l bechtold Jason-Scott l Holly Klaus Thaler John B Marshall Division of Gastroenterology University of Missouri Hospital and Clinics Columbia MO 65212 United States General Surgery University of Missouri Hospital and Clinics Columbia MO 65212 United States

AIM： To investigate if differences exist for patients＇ gastroesophageal reflux as measured by the Bravo ambulatory esophageal pH system between d 1 and d 2.METHODS： A retrospective study of 27 consecutive adult patients who underwent Bravo esophageal pH monitoring was performed. Patients underwent EGD under Ⅳ conscious sedation prior to Bravo placement. Acid reflux variables and symptom scores for d 1 were compared to d 2.RESUlTS： The mean doses of fentanyl and midazolam were 90.4 μg and 7.2 mg, respectively. D 1 results were significantly more elevated than d 2 with respect to total time pH 〈 4, upright position reflux, and mean number of long refluxes. No statistical difference was noted between the two days for supine position reflux, number of refluxes, duration of longest reflux, episodes of heartburn, and symptom score.CONClUSION： Patients undergoing Bravo esophageal pH monitoring in association with EGD and moderate conscious sedation experience significantly more acid reflux on d i compared to d 2. The Ⅳ sedation may be responsible for the increased reflux on d 1. Performed this way, 48-h Bravo results may not be entirely representative of the patients＇ true GE reflux profile.

关键词： Esophageal pH monitoring Bravo Gastroeso- phageal reflux disease Reflux pH testing

How good is endoscopic ultrasound for TNM staging of gastric cancers? A meta-analysis and systematic review

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World Journal of Gastroenterology 2008年第25期14卷 4011-4019页

作者： Srinivas Reddy Puli Jyotsna Batapati Krishna Reddy matthew l bechtold Mainor R Antillon Jamal A Ibdah Division of Gastroenterology and Hepatology University of Missouri-Columbia

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) for staging of gastric cancers. METHODS: Only EUS studies confirmed by surgery were selected. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Articles were searched in Medline, Pubmed, Ovid journals, Cumulative index for nursing & allied health literature, International pharmaceutical abstracts, old Medline, Medline nonindexed citations, and Cochrane control trial registry. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. 2 × 2 tables were constructed with the data extracted from each study. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specifi city, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fi xed effects model) and DerSimonian laird method (random effects model). The heterogeneity of studies was tested using Cochran's Q test based upon inverse variance weights. RESUlTS: Initial search identified 1620 reference articles and of these, 376 relevant articles were selected and reviewed. Twenty-two studies (n = 1896) which met the inclusion criteria were included in this analysis. Pooled sensitivity of T1 was 88.1% (95% CI: 84.5-91.1) and T2 was 82.3% (95% CI: 78.2-86.0). For T3, pooled sensitivity was 89.7% (95% CI: 87.1-92.0). T4 hada pooled sensitivity of 99.2% (95% CI: 97.1-99.9). For nodal staging, the pooled sensitivity for N1 was 58.2% (95% CI: 53.5-62.8) and N2 was 64.9% (95% CI: 60.8-68.8). Pooled sensitivity to diagnose distant metastasis was 73.2% (95% CI: 63.2-81.7). The P for chi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONClUSION: EUS results are more accurate with advanced disease than early disease. If EUS diagnoses advanced disease, such as T4 disease, the patient is 500 times more likely to h

关键词： Gastric cancer Staging Meta-analysis Endoscopic ultrasound

Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis

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World Journal of Gastroenterology 2016年第43期22卷 9642-9649页

作者： matthew Chin William Karnes M Mazen Jamal John G lee Robert lee Jason Samarasena matthew l bechtold Douglas l Nguyen Division of Gastroenterology and Hepatology University of California Irvine Division of Gastroenterology Long Beach Veterans Affairs Health System Division of Gastroenterology University of Missouri Health

AIM To perform meta-analysis of the use of Endocuff during average risk screening *** Scopus, Cochrane databases, MEDlINE/Pub Med, and CINAHl were searched in April 2016. Abstracts from Digestive Disease Week, United European Gastroenterology, and the American College of Gastroenterology meeting were also searched from 2004-2015. Studies comparing EC-assisted colonoscopy(EAC) to standard colonoscopy, for any indication, were included in the analysis. The analysis was conducted by using the Mantel-Haenszel or DerS imonian and laird models with the odds ratio(OR) to assess adenoma detection, cecal intubation rate, and complications performed. RESUlTS Nine studies(n = 5624 patients) were included in the analysis. Compared to standard colonoscopy, procedures performed with EC had higher frequencies for adenoma(OR = 1.49, 95%CI: 1.23-1.80; P = 0.03), and sessile serrated adenomas detection(OR = 2.34 95%CI: 1.63-3.36; P l intubation rates between the EACgroup and standard colonoscopy(OR = 1.26, 95%CI: 0.70-2.27, I2 = 0%; P = 0.44). EAC was associated with a higher risk of complications, most commonly being superficial mucosal injury without higher frequency for *** The use of an EC on colonoscopy appears to improve pre-cancerous polyp detection without any difference in cecal intubation rates compared to standard colonoscopy.

关键词： Colonoscopy Endocuff Adenoma detection

Staging accuracy of esophageal cancer by endoscopic ultrasound:A meta-analysis and systematic review

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World Journal of Gastroenterology 2008年第10期14卷 1479-1490页

作者： Srinivas R Puli Jyotsna BK Reddy matthew l bechtold Daphne Antillon Jamal A Ibdah Mainor R Antillon Division of Gastroenterology and Hepatology University of Missouri-Columbia Columbia Missouri 65212 United States

AIM: To evaluate the accuracy of endoscopic ultrasound (EUS) in the staging of esophageal cancer. METHODS: Only EUS studies confirmed by surgery were selected. Articles were searched in Medline and Pubmed. Two reviewers independently searched and extracted data. Meta-analysis of the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratio. Pooling was conducted by both the Mantel-Haenszel method (fixed effects model) and DerSimonian laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESUlTS: Forty-nine studies (n = 2558) which met the inclusion criteria were included in this analysis. Pooled sensitivity and specificity of EUS to diagnose T1 was 81.6% (95% CI: 77.8-84.9) and 99.4% (95% CI: 99.0-99.7), respectively. To diagnose T4, EUS had a pooled sensitivity of 92.4% (95% CI: 89.2-95.0) and specificity of 97.4% (95% CI: 96.6-98.0). With Fine Needle Aspiration (FNA), sensitivity of EUS to diagnose N stage improved from 84.7% (95% CI: 82.9-86.4) to 96.7% (95% CI: 92.4-98.9). The P value for the χ2 test of heterogeneity for all pooled estimates was > 0.10. CONClUSION: EUS has excellent sensitivity and specificity in accurately diagnosing the TN stage of esophageal cancer. EUS performs better with advanced (T4) than early (T1) disease. FNA substantially improves the sensitivity and specificity of EUS in evaluating N stage disease. EUS should be strongly considered for staging esophageal cancer.

关键词： Esophageal cancer Cancer staging Endoscopic ultrasound, TNM staging, Diagnostic accuracy

Endoscopic ultrasound:It’s accuracy in evaluating mediastinal lymphadenopathy? A meta-analysis and systematic review

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World Journal of Gastroenterology 2008年第19期14卷 3028-3037页

作者： Srinivas R Puli Jyotsna Batapati Krishna Reddy matthew l bechtold Jamal A Ibdah Daphne Antillon Shailender Singh Mojtaba Olyaee Mainor R Antillon Division of Gastroenterology and Hepatology University of Missouri- Columbia Division of Gastroenterology and Hepatology University of Kansas School of Medicine

AIM:To evaluate the accuracy of endoscopic ultrasound (EUS), EUS-fine needle aspiration (FNA) in evaluating mediastinal lymphadenopathy. METHODS:Only EUS and EUS-FNA studies confirmed by surgery or with appropriate follow-up were selected. Articles were searched in Medline, Pubmed, and Cochrane control trial registry. Only studies from which a 2 × 2 table could be constructed for true positive, false negative, false positive and true negative values were included. Two reviewers independently searched and extracted data. The differences were resolved by mutual agreement. Meta-analysis for the accuracy of EUS was analyzed by calculating pooled estimates of sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Pooling was conducted by both Mantel-Haenszel method (fixed effects model) and DerSimonian laird method (random effects model). The heterogeneity of studies was tested using Cochran’s Q test based upon inverse variance weights. RESUlTS:Data was extracted from 76 studies (n = 9310) which met the inclusion criteria. Of these, 44 studies used EUS alone and 32 studies used EUS-FNA. FNA improved the sensitivity of EUS from 84.7% (95% CI:82.9-86.4) to 88.0% (95% CI:85.8-90.0). With FNA, the specificity of EUS improved from 84.6% (95% CI:83.2-85.9) to 96.4% (95% CI:95.3-97.4). The P forchi-squared heterogeneity for all the pooled accuracy estimates was > 0.10. CONClUSION:EUS is highly sensitive and specific for the evaluation of mediastinal lymphadenopathy and FNA substantially improves this. EUS with FNA should be the diagnostic test of choice for evaluating mediastinal lymphadenopathy.

关键词： Endoscopic ultrasound EUS-fine needleaspiration Mediastinal lymphadenopathy

Bowel preparation prior to colonoscopy:A continual search for excellence

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World Journal of Gastroenterology 2013年第2期19卷 155-157页

作者： matthew l bechtold Abhishek Choudhary Division of Gastroenterology University of MissouriColumbiaMO 65201United States Division of Gastroenterology and Hepatology University of Missouri Health Sciences CenterFive Hospital DriveColumbiaMO 65212United States

Bowel preparation prior to colonoscopy is essential to maximize the benefits of *** bowel preparations have been studied,ranging from 4 l polyethylene glycol(PEG) to split-dose regimens to 2 l PEG with an adjunct laxative(senna,bisacodyl,ascorbic acid).Due to the large volume of PEG required for adequate bowel preparation,many studies have focused on reducing this large volume to only 2 l PEG with the addition of an ***,a randomized controlled trial by Tajika et al showed that the addition of mosapride to only 1.5 l PEG was non-inferior to mosapride and 2 l PEG for bowel cleansing but did provide improvements in patient *** study offers yet another potential bowel preparation for patients undergoing colonoscopy and may trigger further studies with 1.5 l PEG with an *** this letter,we discuss the current state of bowel preparation prior to colonoscopy and offer information to guide clinicians on choosing the appropriate bowel preparation for their patients.

关键词： Colonoscopy Polyethylene glycol Mosapride Bowel preparation

Effect of precut sphincterotomy on post-endoscopic retrograde cholangiopancreatography pancreatitis:A systematic review and meta-analysis

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World Journal of Gastroenterology 2014年第14期20卷 4093-4101页

作者： Abhishek Choudhary Jessica Winn Sameer Siddique Murtaza Arif Zainab Arif Ghassan M Hammoud Srinivas R Puli Jamal A Ibdah matthew l bechtold Division of Gastroenterology Department of Internal MedicineUniversity of Missouri-Columbia Division of Gastroenterology and Hepatology University of IllinoisPeoria CampusOSF Saint Francis Medical CenterPeoria

AIM: To conduct a systemic review and meta-analysis to investigate the role of early precut technique. Multiple randomized controlled trails (RCTs) have reported conflicting results of the early precut sphincterotomy.

关键词： Early precut Endoscopic retrograde cholangiopancreatography cannulation Post-endoscopic retrograde cholangiopancreatography pancreatitis Randomized controlled trials Meta-analysis

Weekday vs weekend endoscopy: Is there a true difference in patient outcomes? A meta-analysis

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World Journal of Meta-Analysis 2014年第2期2卷 29-35页

作者： Alisha M Hinds Dina Ahmad Kristi T lopez Michelle l Matteson-Kome matthew l bechtold Division of Gastroenterology and Hepatology University of Missouri School of Medicine

AIM:To evaluate the"weekend effect"on outcomes in patient admitted on the weekend for upper gastrointestinal bleeding(UGIB).METHODS:A comprehensive search was performed(March 2014).Studies comparing weekend and weekday endoscopy in patients with UGIB were *** studies had at least 2 of 3 primary outcomes which included:mortality,need for surgery,time to endoscopy,endoscopy on admission day,and length of hospital *** authors individually extracted *** was performed using pooled estimates with odds ratio or mean difference by fixed and random effects ***:Eleven studies met the inclusion *** admitted with UGIB on the weekend exhibited a statistically significant increase in mortality(OR=1.13;95%CI:1.06-1.20;Plly significant less endoscopy on day of admission(OR=0.72;95%CI:0.62-0.85;Plength of hospital stay(MD-1.29;95%CI:-3.03-0.45;P=0.15).CONClUSION:A weekend effect seems to be apparent in patients with UGIB with significantly poorer outcomes.

关键词： Weekend Weekday Upper gastrointestinal bleeding Endoscopy Meta-analysis

Endoscopic ultrasound-guided fiducial marker placement in pancreatic cancer:A systematic review and meta-analysis

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World Journal of Gastrointestinal Endoscopy 2020年第8期12卷 231-240页

作者： Jaymon B Patel Vakya Revanur David G Forcione matthew l bechtold Srinivas R Puli Department of Gastroenterology University of Illinois College of Medicine at PeoriaPeoriaIL 61637United States Department of Internal Medicine University of Illinois College of Medicine at PeoriaPeoriaIL 61637United States Department of Gastroenterology Massachusetts General HospitalBostonMA 02114United States Department of Gastroenterology University of MissouriColumbiaMO 65203United States

BACKGROUND Pancreatic cancer(PC)mortality remains high despite advances in *** chemoradiotherapy offers modest survival benefit over monotherapy with *** markers serve as needed landmarks for imageguided radiotherapy(IGRT).Traditionally,these markers were placed surgically or percutaneously with limitations of *** ultrasound-guided placement overcomes these *** To evaluate the safety,efficacy,and feasibility of endoscopic ultrasound(EUS)-guided fiducial placement for PC undergoing *** Articles were searched in MEDlINE,PubMed,and Ovid *** was conducted by fixed and random effects *** was assessed using Cochran’s Q test based upon inverse variance *** Initial search identified 1024 reference articles for EUS-guided fiducial placement in *** these,261 relevant articles were *** was extracted from 11 studies(n=820)meeting inclusion *** proportion of successful placement was 96.27%(95%CI:95.35-97.81)with fiducial migration rates low at 4.33%(95%CI:2.45-6.71).Adverse event rates remained low,with overall pooled proportion of 4.85%(95%CI:3.04-7.03).CONClUSION EUS-guided placement of fiducial markers for IGRT of PC is safe,feasible,and *** ability to target deep structures under direct visualization while remaining minimally invasive are added ***,the ability to perform fine needle aspiration or celiac plexus neurolysis add value and increase patient-care *** EUS-guided fiducial placement improves outcomes in IGRT or offers any mortality benefits over traditional placement remains unknown and future studies are needed.

关键词： Endoscopic ultrasound Pancreatic cancer Fiducial marker Image-guided radiotherapy Systematic review Meta-analysis