Iatagan Josino

The Effectiveness of Endoscopic Gastroplasty for Obesity Treatment According to FDA Thresholds: Systematic Review and Meta-Analysis Based on Randomized Controlled Trials

Endoscopic bariatric therapies (EBTs) are promising alternatives to conventional surgery for obesity. The aim of this study is to compare efficacy and safety through a systematic review and meta-analysis of the endoscopic gastroplasty techniques versus conservative treatment. We searched MEDLINE, EMBASE, Cochrane CENTRAL, Lilacs/Bireme. Randomized controlled trials (RCTs) enrolling obese patients comparing endoscopic gastroplasty to sham or diet/exercise were considered eligible. Among 6014 records, three RCTs were selected for meta-analysis. The total sample was 459 patients (312 EBTs vs 147 control). Mean total body weight loss in the intervention group (IG) was 4.8% higher than the control group (CG) at 12xa0months (pu2009=u20090.01). The IG responder rate was 44.31% at 12xa0months. Therefore, the endoscopic gastroplasty is more effective than conservative therapies but do not achieve FDA thresholds.

Colonic stent versus emergency surgery as treatment of malignant colonic obstruction in the palliative setting: a systematic review and meta-analysis

[This corrects the article DOI: 10.1055/a-0591-2883.].

Gastric foreign body removal with a lithotriptor

Figure 1. Capture of foreign body in stomach. A 40-year-old man who had ingested a rubber ball accidentally while drinking a glass of orange juice presented with abdominal pain and 2 bouts of emesis. He underwent EGD for removal of the foreign body in his stomach. Initial attempts included the use of rat-tooth forceps and a snare, both which were unsuccessful because the rubber ball could not be retrieved through the gastroesophageal junction. He was referred to our advanced GI endoscopy center. During repeated endoscopy, foreign body extraction by use of a snare was unsuccessful. Next, we decided to use mechanical lithotripsy to break the ball and remove it in pieces. The 40-mm foreign body was retrieved with a snare after mechanical lithotripsy and after it was fragmented into 4 smaller pieces (Fig. 1 and Video 1, available online at www.VideoGIE.org). The patient recovered without any adverse events and was discharged from the hospital. About 80% of foreign bodies accidentally ingested are eliminated without adverse events. According to the guidelines of the American Society for Gastrointestinal Endoscopy, objects bigger than 2.5 cm are usually unable to pass through the pyloric canal or the ileocecal valve and should be removed within 72 hours. In this case report, early removal was performed because the patient had abdominal pain. The endoscopic management of foreign bodies may vary according to the available material. In this patient’s case, the size and endurance of the material led the endoscopist to choose lithotripsy. In some cases, such as that related by Conway et al, bezoar removal is impossible without shattering it. For that reason, a mechanical lithotriptor was used to make removal feasible. Kedia et al used the same procedure to tear a partially eroded gastric band that had extruded into the gastric lumen. Other authors report different techniques, such as guidewire and snare-assisted techniques. However, capturing a spherical object with a snare would be a real challenge.

Comparison between Enteroscopy-Based and Laparoscopy-Assisted ERCP for Accessing the Biliary Tree in Patients with Roux-en-Y Gastric Bypass: Systematic Review and Meta-analysis

Although balloon-assisted enteroscopy-endoscopic retrograde cholangiopancreatography (BAE-ERCP) is a well-described means of accessing the duodenal papilla in patients with Roux-en-Y gastric bypass (RYGB), it is associated with modest clinical success rates. Laparoscopy-assisted ERCP (LA-ERCP)—performed by advancing a standard duodenoscope through a gastrostomy into the excluded stomach and duodenum—has emerged as a viable alternative to BAE-ERCP, with apparently higher success rates. In this systematic review, we compare LA-ERCP with enteroscopy-based techniques in post-RYGB patients, including 22 case series that provided data on papilla identification, papilla cannulation, and complications. We found that LA-ERCP was superior to the enteroscopy-based techniques in its capacity to reach the duodenal papilla, although complication rates were lower for the latter. Comparative studies are needed in order to corroborate our findings.

Endoscopic Dilation with Bougies versus Balloon Dilation in Esophageal Benign Strictures: Systematic Review and Meta-Analysis

Background The use of bougies and balloons to dilate benign esophageal strictures (BES) is a consolidated procedure. However, the amount of evidence available in scientific literature supporting which is the best technique is very low, despite the great prevalence and importance of such pathology. This systematic review with meta-analysis aims at comparing both techniques, providing good quality of evidence. Methods We searched for randomized clinical trials (RCTs) published from insertion to November 2017, using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, LILACS, and grey literature. After the data extraction, a meta-analysis was performed. The main outcomes were symptomatic relief and recurrence rate. The secondary outcomes were bleeding, perforation, and postprocedure pain. Results We included 5 randomized clinical trials (RCTs), totalizing 461 patients. Among them, 151 were treated with bougie dilation and 225 underwent balloon dilation. Regarding symptomatic relief, recurrence, bleeding, and perforation rates, there were no differences between the methods. Concerning postprocedure pain, patients submitted to balloon dilation had less intense pain (RD 0.27, 95% IC −0.42 to −0.07, P = 0.007). Conclusion We conclude that there is no difference between bougie and balloon dilation of BESs regarding symptomatic relief, recurrence rate at 12 months, bleeding, and perforation. Patients undergoing balloon dilation present less severe postprocedure pain.