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Is there a difference between 19G core biopsy needle and 22G core biopsy needle in diagnosing the correct etiology?——A meta-analysis and systematic review

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World Journal of Meta-Analysis 2017年第2期5卷 54-62页

作者： Manasa Kandula Matthew L Bechtold Kaninika Verma Bhagat S Aulakh Deepak Taneja srinivas r puli Division of Internal Medicine University of Illinois College of Medicine at Peoria Division of Gastroenterology and Hepa-tology University of Missouri School of Medicine at Columbia Illinois Lung and Critical Care Institute University of Illinois College of Medicine at Peoria Division of Gastroenterology and Hepatology University of Illinois College of Medicine at Peoria

AIM To compare the accuracy of endoscopic ultra-sonography(EUS) 19 G core biopsies and 22 G core biopsies in diagnosing the correct etiology for a solid *** Articles were searched in Medline, Pub Med, and Ovid journals. Pooling was conducted by both fixed and random effects models. rESULTS Initial search identified 4460 reference articles for 19 G and 22 G, of these 670 relevant articles were selected and reviewed. Data was extracted from 6 studies for 19G(n = 289) and 16 studies for 22G(n = 592) which met the inclusion criteria. EUS 19 G core biopsies had a pooled sensitivity of 91.6%(95%CI: 87.1-95.0) and pooled specificity of 95.9%(95%CI: 88.6-99.2), whereas EUS 22 G had a pooled sensitivity of 83.3%(95%CI: 79.7-86.6) and pooled specificity of 64.3%(95%CI: 54.7-73.1). The positive likelihood ratio of EUS 19 G core biopsies was 9.08(95%CI: 1.12-73.66) and EUS 22 G core biopsies was 1.99(95%CI: 1.09-3.66).The negative likelihood ratio of EUS 19 G core biopsies was 0.12(95%CI: 0.07-0.24) and EUS 22 G core biopsies was 0.25(95%CI: 0.14-0.41). The diagnostic odds ratio was 84.74(95%CI: 18.31-392.26) for 19 G core biopsies and 10.55(95% CI: 3.29-33.87) for 22 G needles. CONCLUSION EUS 19 G core biopsies have an excellent diagnostic value and seem to be better than EUS 22 G biopsies in detecting the correct etiology for a solid mass.

关键词： Endoscopic ultrasound guided fine needle aspiration Solid mass lesions Endoscopic ultrasound Pancreatic mass Pancreatic cytology Core biopsies 19G procore needle Meta-analysis Systematic review 22G procore needle

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Ascorbic acid and low-volume polyethylene glycol for bowel preparation prior to colonoscopy:A meta-analysis

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World Journal of Meta-Analysis 2013年第1期1卷 10-15页

作者： Jonathan D Godfrey robert E Clark Abhishek Choudhary Imran Ashraf Michelle L Matteson srinivas r puli Matthew L Bechtold Division of Gastroenterology University of Missouri Columbia MO 65212 United States OSF MG Gastroenterology University of Illinois Peoria IL 61604 United States

AIM: To evaluate the benefits of low-volume polyethylene glycol(PEG) with ascorbic acid compared to fulldose PEG for colonoscopy preparation. METHODS: MEDLINE, Cochrane Central register of Controlled Trials and Database of Systematic reviews, CINAHL, Pub Med, and recent abstracts from major conferences were searched(January 2012). Only randomized-controlled trials on adult subjects comparing lowvolume PEG(2 L) with ascorbic acid vs full-dose PEG(3 or 4 L) were included. Meta-analysis for the efficacy of low-volume PEG with ascorbic acid and full-dose PEG were analyzed by calculating pooled estimates of number of satisfactory bowel preparations as well as adverse patient events(abdominal pain, nausea, vomiting). Separate analyses were performed for each main outcome by using Or with fixed and random effects models. Heterogeneity was assessed by calculating the I2 measure of inconsistency. rev Man 5.1 was utilized for statistical ***: The initial search identified 242 articles and trials. Nine studies(n = 2911) met the inclusion criteria and were analyzed for this meta-analysis with mean age range from 53.0 to 59.6 years. All studies were randomized controlled trials on adult patients comparing large-volume PEG solutions(3 or 4 L) with low-volume PEG solutions and ascorbic acid. No statistically significant difference was noted between lowvolume PEG with ascorbic acid and full-dose PEG for number of satisfactory bowel preparations(Or 1.07, 95%CI: 0.86-1.33, P = 0.56). No statistically significant difference was noted between low-volume PEG with ascorbic acid and full-dose PEG for abdominal pain(Or 1.09, 95%CI: 0.81-1.48, P = 0.56), nausea(Or 0.70, 95%CI: 0.49-1.00, P = 0.05), or vomiting(Or 0.99, 95%CI: 0.78-1.26, P = 0.95). No publication bias was ***: Low-volume PEG with the addition of ascorbic acid demonstrates no statistically significant difference to full-dose PEG for satisfactory bowel preparation and side-effects.

关键词： Polyethylene glycol Ascorbic acid Colonoscopy Meta-analysis Bowel preparation

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Use of music during colonoscopy:An updated meta-analysis of randomized controlled trials

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World Journal of Meta-Analysis 2019年第9期7卷 428-435页

作者： ryan D Heath Nasim Parsa Michelle L Matteson-Kome Victoria Buescher Sami Samiullah Douglas L Nguyen Veysel Tahan Yezaz A Ghouri srinivas r puli Matthew L Bechtold Division of Gastroenterology University of Missouri School of MedicineColumbiaMO 65212United States Division of Gastroenterology Heart of the Rockies Regional Medical CenterColorado SpringsCO 80907United States Division of Gastroenterology University of Illinois–PeoriaPeoriaIL 61604United States

BACKGrOUND Music seems to be beneficial in multiple clinical *** is a stressful event for patients,especially with conscious *** during colonoscopy has been evaluated in multiple randomized controlled trials(rCTs)with varied *** meta-analyses on the subject over the years have yielded inconsistent ***,we conducted an up-to-date meta-analysis regarding music during *** To assess the effects of music played during colonoscopy on patients’perspectives and sedation *** Multiple large databases were aggressively searched(November 2018).rCTs comparing music to without music during colonoscopy on adult patients were *** estimates were calculated for sedative medication doses,total procedure time,and patients’experience,willingness to repeat procedure,and pain scores using odds ratio(Or)and mean difference(MD)with random effects *** Eleven studies(n=988)were *** during colonoscopy showed a statistically significant reduction in procedure times(MD:-2.3 min;95%CI:-4.13 to-0.47;P=0.01)and patients’pain(MD:-1.26;95%CI:-2.28 to-0.24;P=0.02)while improving patients’experience(MD:-1.11;95%CI:-1.7 to-0.53;Pred to no *** statistically significant differences were observed between music and no music during colonoscopy for midazolam(MD:-0.4 mg;95%CI:-0.9 to 0.09;P=0.11),meperidine(MD:-3.06 mg;95%CI:-10.79 to 4.67;P=0.44),or patients’willingness to repeat the colonoscopy(Or:3.89;95%CI:0.76 to 19.97;P=0.1).CONCLUSION Music appears to improve overall patient experience while reducing procedure times and patient ***,music,being a non-invasive intervention,should be strongly considered during colonoscopy.

关键词： Colonoscopy Music relaxation Meta-analysis

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Split-dose vs same-day bowel preparation for afternoon colonoscopies:A meta-analysis of randomized controlled trials

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World Journal of Meta-Analysis 2020年第6期8卷 461-470页

作者： Nasim Parsa Eric A Grisham Courtney J Cockerell Michelle L Matteson-Kome ramakrishna V Bysani SamiSamiullah Douglas L Nguyen Veysel Tahan Yezaz A Ghouri srinivas r puli Matthew L Bechtold Division of Gastroenterology and Hepatology Department of MedicineUniversity of Missouri-ColumbiaColumbiaMO 65212United States Division of Gastroenterology Heart of the Rockies Regional Medical CenterColorado SpringsCO 80907United States Division of Gastroenterology University of Illinois-PeoriaPeoriaIL 61604United States

BACKGrOUND Quality of bowel preparation in afternoon colonoscopies has been a ***,a choice of same-day preparation(SaD)or split-dose preparation(SpD)exists;however,randomized controlled trials’results have *** To examine the outcomes of SaD and SpD for afternoon *** An extensive literature search was conducted using multiple *** randomized controlled trials(rCTs)in adults that compared SaD to SpD with Ottawa bowel preparation score(OBPS)were *** ratio(Or)or mean difference was used to analyze *** Eleven rCTs were included(n=1846).No difference was observed for satisfactory bowel preparation based on OBPS among participants receiving SaD vs SpD(Or 0.77;95%CI:-0.57-1.03;P=0.07;I2=5%).Subgroup analysis showed no difference in terms of satisfactory bowel preparation based on OBPS between the two groups when receiving same preparation formula(polyethylene glycol)(Or 0.83;95%CI:0.51-1.35;P=0.46;I2=39%)as well as receiving same formula and volume(4 L polyethylene glycol)(Or 1.14;95%CI:0.65-2.01;P=0.64;I2=0%).CONCLUSION In patients undergoing afternoon colonoscopies,SaD is comparable with SpD in terms of satisfactory bowel *** studies are needed to validate these results and determine the optimal formula and dosages.

关键词： Afternoon Colonoscopy Preparation Split-dose Same-day Meta-analysis

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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

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recent advances in vaccination of non-responders to standard dose hepatitis B virus vaccine

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World Journal of Hepatology 2015年第24期7卷 2503-2509页

作者： Saqib Walayat Zohair Ahmed Daniel Martin srinivas puli Michael Cashman Sonu Dhillon Department of Gastroenterology andHepatology University of Illinois PeoriaCampusOSF Saint Francis Medical Center Department of Internal Medicine Universityof Illinois Peoria CampusOSF Saint Francis Medical Center

Hepatitis B virus(HBV) infection is a global health problem. It is estimated there are more than 2 billion individuals exposed to the virus and 250 million are chronically infected. Hepatitis B is the cause of more than 600000 annual deaths due to cirrhosis and hepatocellular carcinoma. An effective vaccine exists and preventative initiatives center around universal vaccination especially in those at highest risk. Effective vaccination algorithms have led to a significant decline in the development of new infections and its devastating consequences. The vaccine is administered intramuscularly in three doses, with 95% showing long lasting serologic immunity. An additional fourth dose or a repeated higher dose three course regimen is given to those that fail to show immunity. Despite these additional regimens, some remain vulnerable to hepatitis B and are deemed nonresponders. Individuals with chronic disease states such as kidney disease, liver disease, diabetes mellitus, as well as those with a genetic predisposition, and those on immunomodulation therapy, have the highest likelihood of non-response. Various strategies have been developed to elicit an immune response in these individuals. These include increased vaccination dose, intradermal administration, alternative adjuvants, alternative routes of administration, co-administration with other vaccines, and other novel therapies. These alternative strategies can show improved response and lasting immunity. In summary, HBV vaccination is a major advance of modern medicine and all individuals at risk should be sought and vaccinated with subsequent adequate titers demonstrated.

关键词： Hepatitis B vaccine Non-responders Intradermal vac

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Progression from low-grade dysplasia to malignancy in patients with Barrett's esophagus diagnosed by two or more pathologists

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World Journal of Gastroenterology 2016年第39期22卷 8831-8843页

作者： Harsha Moole Jaymon Patel Zohair Ahmed Abhiram Duvvuri Sreekar Vennelaganti Vishnu Moole Sowmya Dharmapuri raghuveer Boddireddy Pratyusha Yedama Naveen Bondalapati Achuta Uppu Prashanth Vennelaganti srinivas puli Department of Medicine University of Illinois College of Medicine at Peoria Division of Gastro-enterology and Hepatology Kansas City Veteran Affairs Medical Center Department of Medicine Apogee Medical Group Department of Medicine NTR University of Health Sciences Department of Medicine Barnes Jewish Christian Medical Group Christian Hospital Department of Medicine Albert Einstein College of Medicine Division of Gastroenterology and Hepatology University of Kansas Medical Center Division of Gastroenterology and Hepatology University of Illinois College of Medicine at Peoria

AIM To evaluate annual incidence of low grade dysplasia(LGD) progression to high grade dysplasia(HGD) and/or esophageal adenocarcinoma(EAC) when diagnosis was made by two or more expert *** Studies evaluating the progression of LGD to HGD or EAC were included. The diagnosis of LGD must be made by consensus of two or more expert gastrointestinal pathologists. Articles were searched in Medline, Pubmed, and Embase. Pooled proportions were calculated using fixed and random effects model. Heterogeneity among studies was assessed using the I2 statistic. rESULTS Initial search identified 721 reference articles, of which 53 were selected and reviewed. Twelve studies(n = 971) that met the inclusion criteria were included in this analysis. Among the total original LGD diagnoses in the included studies, only 37.49% reached the consensus LGD diagnosis after review by two or more expert pathologists. Total follow up period was 1532 patient-years. In the pooled consensus LGD patients, the annual incidence rate(AIr) of progression to HGD and or EAC was 10.35%(95%CI: 7.56-13.13) and progression to EAC was 5.18%(95%CI: 3.43-6.92). Among the patients down staged from original LGD diagnosis to No-dysplasia Barrett's esophagus, the AIr of progression to HGD and EAC was 0.65%(95%CI: 0.49-0.80). Among the patients down staged to Indefinite for dysplasia, the AIr of progression to HGD and EAC was 1.42%(95%CI: 1.19-1.65). In patients with consensus HGD diagnosis, the AIr of progression to EAC was 28.63%(95%CI: 13.98-43.27). CONCLUSION When LGD is diagnosed by consensus agreement of two or more expert pathologists, its progression towards malignancy seems to be at least three times the current estimates, however it could be up to 20 times the current estimates. Biopsies of all Barrett's esophagus patients with LGD should be reviewed by two expert gastroenterology pathologists. Follow-up strict surveillance programs should be in place for these patients.

关键词： Barrett’s esophagus Low grade dysplasia High grade dysplasia Esophageal adenocarcinoma Annual incidence of progression Systematic review Meta-analysis

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