Ralph Duarte

Computed tomography colonography versus colonoscopy for the diagnosis of colorectal cancer: a systematic review and meta-analysis

Colorectal cancer (CRC) is a significant cause of morbidity and mortality. Optical colonoscopy (OC) is the first choice of investigation for assessing the state of the colon and it is excellent for CRC screening. Newer technologies such as computed tomography colonography (CTC) may also be useful in CRC screening. This systematic review compares the benefits of CTC and OC for CRC screening. This review includes all the available randomized clinical trials comparing CTC and OC for CRC screening in asymptomatic patients. Three studies were included in the systematic review and were submitted for meta-analysis. In the analysis of participation rates, only 2,333 of 8,104 (29%) patients who were invited for screening underwent the CTC, and only 1,486 of the 7,310 (20%) patients who were invited for screening underwent OC. The absolute risk difference in participation rate in the two procedures was 0.1 (95% CI, 0.05–0.14) in favor of CTC. In the analysis of advanced colorectal neoplasia (ACN) detection rates, 2,357 patients undergoing CTC and 1,524 patients undergoing OC were included. Of these, 135 patients (5.7%) who underwent a CTC and 130 patients (8.5%) who underwent an OC were diagnosed with ACN. The absolute risk difference in ACN detection rate in the two procedure types was −0.02 (with a 95% CI between −0.04 and −0.00) in favor of OC. CTC is an option for CRC screening in asymptomatic patients. However, as CTC was inferior in detecting ACN, it should not replace OC, which remains the gold standard.

A comparison of the efficiency of 22G versus 25G needles in EUS-FNA for solid pancreatic mass assessment: A systematic review and meta-analysis

Our aim in this study was to compare the efficiency of 25G versus 22G needles in diagnosing solid pancreatic lesions by EUS-FNA. We performed a systematic review and meta-analysis. Studies were identified in five databases using an extensive search strategy. Only randomized trials comparing 22G and 25G needles were included. The results were analyzed by fixed and random effects. A total of 504 studies were found in the search, among which 4 randomized studies were selected for inclusion in the analysis. A total of 462 patients were evaluated (233: 25G needle/229: 22G needle). The diagnostic sensitivity was 93% for the 25G needle and 91% for the 22G needle. The specificity of the 25G needle was 87%, and that of the 22G needle was 83%. The positive likelihood ratio was 4.57 for the 25G needle and 4.26 for the 22G needle. The area under the sROC curve for the 25G needle was 0.9705, and it was 0.9795 for the 22G needle, with no statistically significant difference between them (p=0.497). Based on randomized studies, this meta-analysis did not demonstrate a significant difference between the 22G and 25G needles used during EUS-FNA in the diagnosis of solid pancreatic lesions.

Endoscopic treatment of upper-GI ulcer bleeding with hemostatic powder spray

Peptic ulcer is the most common cause of upper-GI bleeding (UGIB). Despite the advances in the management of this condition, mortality remains significant, at 10%. Hemospray (TC-325, Cook Medical, Bloomington, Ind) is a new hemostatic modality that has shown interesting results in a variety of causes, either as monotherapy or as rescue therapy, apparently with the advantage of its easy applicability, especially in difficult situations. Hemospray consists of a mineral powder that absorbs water when applied into the actively bleeding lesion, forming a mechanical barrier over the bleeding site. A 58-year-old man experienced major in-hospital UGIB. The patient did not describe previous diseases and presented to the emergency department with progressive dyspnea. A CT scan showed small nodules uniformly distributed throughout both lungs, suggestingmiliary tuberculosis asso-

Massive bleeding after plastic stent removal during ERCP: what’s next?

Portal biliopathy or portal cavernoma cholangiopathy refers to cholangiographic abnormalities, which occur in patients with portal cavernoma. These include shallow bile duct impressions and indentations causing wall irregularity, smooth strictures with upstream dilatation, and luminal filling defects (▶Fig. 1, ▶Fig. 2). These changes occur as a result of pressure on bile ducts from bridging tortuous paracholedochal, epicholedochal, and cholecystic veins [1]. Symptoms of portal cavernoma cholangiopathy include longstanding jaundice due to chronic cholestasis, or biliary pain with or without cholangitis due to biliary stones [2]. We present the case of a 41-year-old man with portal biliopathy secondary to noncirrhotic portal vein thrombosis, who was admitted with obstructive jaundice and cholangitis. He had a biliary plastic stent placed 2months earlier for obstructive jaundice. The previous stent had become blocked and was removed. A sudden spurt of massive bleeding from the ampulla was noticed. A fully covered self-expandable metal stent (fcSEMS; Wallflex biliary fcSEMS, 10×60mm; Boston Scientific, Marlborough, Massachusetts, USA) was deployed, with resolution of the hemorrhage (▶Video 1). The second case involves endoscopic retrograde cholangiopancreatography (ERCP) in a 54-year-old woman with portal hypertension and cholangitis. Hemobilia was noticed after balloon sweeping. A fcSEMS was used with success (▶Video 1). ERCP with plastic stent exchanges is the first-line intervention for jaundice or cholangitis due to biliary strictures. If E-Videos