检索结果-南通市图书馆

Escalating complexity of endoscopic retrograde cholangiopancreatography over the last decade with increasing reliance on advanced cannulation techniques

引用

World Journal of Gastroenterology 2020年第41期26卷 6391-6401页

作者： Monique T Barakat Mohit Girotra nirav thosani Shivangi Kothari Subhas Banerjee Divisions of Adult and Pediatric Gastroenterology and Hepatology Stanford University Medical CenterCupertinoCA 95014United States Division of Gastroenterology and Hepatology University of Miami Miller School of MedicineMiamiFL 33136United States Department of Internal Medicine Division of GastroenterologyHepatology&NutritionUniversity of Texas Health Science Center HoustonHoustonTX 77030United States Division of Gastroenterology and Hepatology University of Rochester Medical CenterRochesterNY 14627United States Division of Gastroenterology and Hepatology Stanford University Medical CenterStanfordCA 94304United States

BACKGROUND At our academic tertiary care medical center, we have noted patients referred for endoscopic retrograde cholangiopancreatography(ERCP) who increasingly require advanced cannulation techniques. This trend is noted despite increased endoscopist experience and annual ERCP volume over the same *** To evaluate this phenomenon of perceived escalation in complexity of cannulation at ERCP and assessed potential underlying *** Demographic/clinical variables and records of ERCP patients at the beginning(2008), middle(2013) and end(2018) of the last decade were reviewed retrospectively. Cannulation approaches were classified as "standard" or "advanced" and duodenoscope position was labeled as "standard"(short position) or "non-standard"(e.g., long, semi-long).RESULTS Patients undergoing ERCP were older in 2018 compared to 2008(69.7 ± 15.2 years vs 55.1 ± 14.7, P 4 cm, pancreatic uncinate mass, and bilirubin > 10 mg/d L predicted use of advanced cannulation techniques(P < 0.03 for each).CONCLUSION Complexity of cannulation at ERCP has sharply increased over the past 5 years, with an increased proportion of elderly patients and those with malignancy requiring advanced cannulation approaches. These data suggest that complexity of cannulation at ERCP may be predicted based on patient/ampulla characteristics. This may inform selection of experienced, high-volume endoscopists to perform these complex procedures.

关键词： Endoscopic retrograde cholangiopancreatography Biliary cannulation Goff trans-pancreatic septotomy Needle knife precut sphincterotomy Endoscopy Complexity

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

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

引用

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).

关键词： Colorectal Cancer Flexible sigmoidoscopy Randomized control trials Meta-analysis Mortality Incidence

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Photodynamic therapy vs radiofrequency ablation for Barrett's dysplasia: Efficacy,safety and cost-comparison

引用

World Journal of Gastroenterology 2013年第41期19卷 7106-7113页

作者： Atilla Ertan Irum Zaheer Arlene M Correa nirav thosani Shanda H Blackmon Ertan Digestive Disease Center Memorial Hermann HospitalTexas Medical CenterHoustonTX 77030United States Division of Gastroenterology Hepatology and NutritionThe University of Texas Health Science Center at HoustonHoustonTX 77030United States Division of Gastroenterology The Methodist HospitalHoustonTX 77030United States Division of Thoracic and Cardiovascular Surgery The University of Texas MD Anderson Cancer CenterHoustonTX 77030United States Department of Surgery The Methodist HospitalHoustonTX 77030United States

AIM:To compare effectiveness,safety,and cost of photodynamic therapy(PDT)and radiofrequency ablation(RFA)in treatment of Barrett’s dysplasia(BD).METHODS:Consecutive case series of patients undergoing either PDT or RFA treatment at single center by a single investigator were ***-three patients with high-grade dysplasia(HGD)had treatment with porfimer sodium photosensitzer and 630 nm laser(130 J/cm),with maximum of 3 treatment ***-three patients with BD(47 with low-grade dysplasia-LGD,6 with HGD)had step-wise circumferential and focal ablation using the HALO system with maximum of 4 treatment *** groups received proton pump inhibitors twice *** biopsies were acquired at 2 and 12 mo after enrollment,with 4-quadrant biopsies every 1 cm of the original BE extent.A complete histological resolution response of BD(CR-D)was defined as all biopsies at the last endoscopy session negative for ***’s exact test was used to assess differences between the two study groups for primary *** all outcomes,a two-sided P value of less than 0.05 was considered to indicate statistical ***:Thirty(91%)PDT patients and 39(74%)RFA were men(P=0.05).The mean age was 70.7±12.2 and 65.4±12.7(P=0.10)year and mean length of BE was 5.4±3.2 cm and 5.7±3.2 cm(P=0.53)for PDT and RFA patients,*** CR-D was(18/33)54.5%with PDT vs(47/53)88.7%with RFA(P=0.001).One patient with PDT had an esophageal perforation and was managed with non-surgical measures and no perforation was seen with *** was five times more costly than RFA at our *** two groups were not randomized and had different BD grading are the limitations of the ***:In our experience,RFA had higher rate of CR-D without any serious adverse events and was less costly than PDT for endoscopic treatment of BD.

关键词： Barrett’s esophagus Dysplasia Photodynamic therapy Radiofrequency ablation Cost comparison

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

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

引用

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

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

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

引用

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 retro-grade view to visualize lesions on the proximal aspects of folds and fexures. We searched MEDLINE （PubMed 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 colonoscopy. DerSimonian Laird random effects model was used to generate the overall effect for each outcome. We evaluated statistical heterogeneity among the studies by using the Cochran Q statistic and quantifed by I2 ***： Four distinct studies with a total of 920 pa-tients, mean age 59.83 （95%CI： 56.77-62.83） years, were included in the review. The additional adenoma detection rate （AADR） defined as the number of ad-ditional adenomas identified due to “third eye retro-scope” 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）, respectively. AADR 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）, respectively. The ad-ditional polyp detection rate defined as the number of additional polyps identifed due to “third eye retro-scope” device in comparison to standard colonoscopyalone was 19.8% （95%CI： 7.9-41.8）. There were no complications reported with use of “third eye retro-scope” ***： The “third eye retroscope” device when used with standard colonoscopy is safe and de-tects 19.9% additional adenomas, compared to stan-dard colonoscopy alone.

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

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Endoscopic retrograde cholangiopancreatography-related early perforations:A study of effects of procedure duration,complexity,and endoscopist experience

引用

World Journal of Gastrointestinal Endoscopy 2023年第11期15卷 641-648页

作者： Mark Aloysius Hemant Goyal Tejas Nikumbh Niraj James Shah Ghassan M Hammoud Pritesh Mutha Mairin Joseph-Talreja Savio John Ganesh Aswath Vaibhav Wadhwa nirav thosani Division of Gastroenterology Department of Internal MedicineSUNY Upstate Medical UniversitySyracuseNY13210United States Department of Surgery The University of Texas Health Science CenterHoustonTX 77030United States Department of Internal Medicine The Wright Center for Graduate Medical EducationScrantonPA 18510United States Department of Medicine Division of Digestive DiseasesThe University of Missouri at ColumbiaColumbiaMO 65211United States Division of Gastroenterology Department of Internal MedicineSUNY Upstate Medical UniversitySyracuseNY 13210United States

BACKGROUND Perforations(Perf)during endoscopic retrograde cholangiopancreatography(ERCP)are rare(<1%)but potentially fatal events(up to 20%mortality).Given its rarity,most data is through case series studies from centers or analysis of large *** a meta-analysis has shown fewer adverse events as a composite(bleeding,pancreatitis,Perf)during ERCP performed at high-volume centers,there is very little real-world data on endoscopist and center procedural volumes,ERCP duration and complexity on the occurrence of *** To study the profile of Perf related to ERCP by center and endoscopist procedure volume,ERCP time,and complexity from a national endoscopic *** from clinical outcomes research initiative-national endoscopic database(2000-2012)who underwent ERCP were stratified based on the endoscopist and center volume(quartiles),and total procedure duration and complexity grade of the ERCP based on procedure *** effects of these variables on the Perf that occurred were *** variables were compared between Perf and no perforations(NoPerf)using the Mann-Whitney U test as the data demonstrated significant skewness and *** A total of 14153 ERCPs were performed by 258 endoscopists,with 20 reported Perf(0.14%)among 16 *** patient age in years 61.6±14.8 vs 58.1±18.8(Perf ***,P=NS).The cannulation rate was 100%and 91.5%for Perf and NoPerf groups,respectively.13/20(65%)of endoscopists were high-volume performers in the 4th quartile,and 11/20(55%)of Perf occurred in centers with the highest volumes(4th quartile).Total procedure duration in minutes was 60.1±29.9 vs 40.33±23.5(Perf vs NoPerf,P<0.001).Fluoroscopy duration in minutes was 3.3±2.3 vs 3.3±2.6(Perf vs NoPerf P=NS).50%of the procedures were complex and greater than grade 1 difficulty.3/20(15%)patients had prior biliary surgery.13/20(65%)had sphincterotomies performed with stent *** occurred in only 1/20(0.5%).CONCLUSION

关键词： Endoscopic retrograde cholangiopancreatography Endoscopy complications Perforations

来源：

维普期刊数据库评论

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

欢迎您,

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

请选择保存的检索档案：

请选择收藏分类：

通借通还

欢迎您,

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

在线全文

在线全文

在线全文

在线全文

在线全文

在线全文

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：