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World Journal of Gastroenterology 2024年第29期30卷 3534-3537页

作者： Faisal S Ali sushovan guha Department of Gastroenterology Hepatologyand NutritionUniversity of Texas Health Science Center at HoustonHustonTX 77054United States Department of Clinical Sciences Tilman J.Fertitta Family College of MedicineUniversity of HoustonHoustonTX 77204United States

The role of endoscopy in pathologies of the bile duct and gallbladder has seen notable advancements over the past two *** advancements in stent technology,such as the development of lumen-apposing metal stents,and adoption of endoscopic ultrasound and electrosurgical principles in therapeutic endoscopy,what was once considered endoscopic failure has transformed into failure of an approach that could be salvaged by a second-or third-line endoscopic *** of these advancements in routine patient care will require formal training and multidisciplinary acceptance of established techniques and collaboration for advancement of experimental techniques to generate robust evidence that can be utilized to serve patients to the best of our ability.

关键词： Endoscopic ultrasound Guided biliary drainage Gallbladder Biliary obstruction Lumen-apposing metal stent

Reduced incidence and mortality from colorectal cancer with flexible-sigmoidoscopy screening: A meta-analysis

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World Journal of Gastroenterology 2014年第48期20卷 18466-18476页

作者： Jennifer Shroff Nirav Thosani Sachin Batra Harminder Singh sushovan guha Division of Gastroenterology Hepatology and NutritionThe University of Texas Medical School at Houston 77030 TXUnited States Departments of Internal Medicine and Community Health Sciences and IBD Clinical and Research Centre University of Manitoba Winnipeg MB R3T 2N Canada

AIM:To conduct a systematic review and meta-analysis of published population-based randomized controlled trials(RCTs).METHODS:RCTs evaluating the difference in mortality and incidence of colorectal cancer(CRC)between a screening flexible sigmoidoscopy(FS)group and control group(not assigned to screening FS)with a minimum 5 years median follow-up were identified by a search of MEDLINE and EMBASE databases and the Cochrane Central Register for Controlled Trials through August *** effects model was used for ***:Four RCTs with a total of 165659 patientsin the FS group and 249707 patients in the control group were included in ***-totreat analysis showed that there was a 22%risk reduction in total incidence of CRC(RR=0.78,95%CI:0.74-0.83),31%in distal CRC incidence(RR=0.69,95%CI:0.63-0.75),and 9%in proximal CRC incidence(RR=0.91,95%CI:0.83-0.99).Those who underwent screening FS were 18%less likely to be diagnosed with advanced CRC(OR=0.82,95%CI:0.71-0.94).There was a 28%risk reduction in overall CRC mortality(RR=0.72,95%CI:0.65-0.80)and 43%in distal CRC mortality(RR=0.57,95%CI:0.45-0.72).CONCLUSION:This meta-analysis suggests that screening FS can reduce the incidence of proximal and distal CRC and mortality from distal CRC along with reduction in diagnosis of advanced CRC.

关键词： Colorectal Cancer Flexible sigmoidoscopy Randomize

Role of self-expanding metal stents in patients with malignant colorectal obstruction: A systematic review and meta-analysis

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World Journal of Meta-Analysis 2015年第6期3卷 232-253页

作者： Nirav Thosani Subhas Banerjee Vikesh Khanijow Bhavana Rao Priyanka Priyanka Atilla Ertan sushovan guha Division of Gastroenterology and Hepatology Stanford University School of Medicine Division of Gastroen- terology Hepatology and Nutrition Department of Internal Medicine the University of Texas Health Medical School at Houston Ertan Digestive Disease Center Memorial Hermann Hospital--TMC

AIM: To assess the safety and efficacy of self-expandable metal stents(SEMSs) for malignant colorectal obstruction. METHODS: Data regarding technical success, clinical success, and procedure related complications were collected from included studies. Der Simonian-Laird random effects model was used to generate the overall outcome. Thirty international studies with a total of 2058 patients with malignant colorectal obstruction were included. RESULTS: The technical and clinical success rates for SEMS placement were 94%(95%CI: 92-96) and 91%(95%CI: 88-93), respectively. Overall complication rate for SEMS was 23%(95%CI: 18-29). Stent migration8%(95%CI: 6-10) and stent obstruction 8%(95%CI: 6-11) were the most common complications, followed by perforation 5%(95%CI: 4%-7%). Surgical or endoscopic re-interventions were needed in 14%(95%CI: 10-18) of patients. Endoscopic repeat stent placement was required in 8%(95%CI: 6-10), while surgical intervention was needed in 6%(95%CI: 4-8).CONCLUSION: SEMS are effective when used as palliation or bridge to surgery for malignant colorectal obstruction with high technical and clinical success. About 14% of patients require repeat endoscopic or surgical intervention for stent failure or to manage stent related complications.

关键词： Metal stent Colorectal cancer Colon cancer Rectal cancer Intestinal obstruction Bowel obstruction Malignant obstruction Colonic obstruction

Diagnostic yield of third eye retroscope on adenoma detection during colonoscopy:A systematic review and meta-analysis

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World Journal of Meta-Analysis 2014年第4期2卷 162-170页

作者： Nirav Thosani Bhavana Rao Sachin Batra Babatunde Adeyefa Gottumukkala S Raju Robert S Bresalier Subhas Banerjee sushovan guha Division of Gastroenterology Hepa-tology and Nutrition The University of Texas Medical School Houston TX 77030 United States Department of Gastroenterology Hepatology and Nutrition The University of Texas MD Anderson Cancer Center Houston TX 77030 United States Department of Gastroen-terology Stanford University Stanford California CA 94305 United States

AIM: To determine the diagnostic yield of the "third eye retroscope",on adenoma detection rate during screening ***: The "third eye retroscope" when used with standard colonoscopy provides an additional retrograde view to visualize lesions on the proximal aspects of folds and *** searched MEDLINE(Pub Med and Ovid),SCOPUS(including MEDLINE and EMBASE databases),Cochrane Database of Systemic Reviews,Google Scholar,and CINAHL Plus databases to identify studies that evaluated diagnostic yield of "third eye retroscope" during screening *** Simonian Laird random effects model was used to generate the overall effect for each *** evaluated statistical heterogeneity among the studies by using the Cochran Q statistic and quantified by I2 ***: Four distinct studies with a total of 920 patients,mean age 59.83(95%CI: 56.77-62.83) years,were included in the *** additional adenoma detection rate(AADR) defined as the number of additional adenomas identified due to "third eye retroscope" device in comparison to standard colonoscopy alone was 19.9%(95%CI: 7.3-43.9).AADR for right and left colon were 13.9%(95%CI: 9.4-20) and 10.7(95%CI: 1.9-42),*** for polyps ≥ 6 mm and ≥ 10 mm were 24.6%(95%CI: 16.6-34.9) and 24.2%(95%CI: 12.9-40.8),*** additional polyp detection rate defined as the number of additional polyps identified due to "third eye retroscope" device in comparison to standard colonoscopy alone was 19.8%(95%CI: 7.9-41.8).There were no complications reported with use of "third eye retroscope" ***: The "third eye retroscope" device when used with standard colonoscopy is safe and detects 19.9% additional adenomas,compared to standard colonoscopy alone.

关键词： Third Eye Retroscope Screening colonoscopy Adenoma detection rate Polyp detection rate Additional adenoma detection rate Additional polyp detection rate