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1.
《Digestive and liver disease》2023,55(7):856-864
IntroductionVarious endoscopic resection techniques have been proposed for the treatment of nonpedunculated colorectal polyps sized 6–20 mm, however the optimal technique still remains unclear.MethodsA comprehensive literature review was conducted for randomized controlled trials (RCTs), investigating the efficacy of endoscopic treatments for the management of 6–20 mm nonpedunculated colorectal polyps. Primary outcomes were complete and en bloc resection rates and adverse event rate was the secondary. Effect size on outcomes is presented as risk ratio (RR; 95% confidence interval [CI]).ResultsFourteen RCTs (5219 polypectomies) were included. Endoscopic mucosal resection(EMR) significantly outperformed cold snare polypectomy(CSP) in terms of complete [(RR 95%CI): 1.04(1.00–1.07)] and en bloc resection rate [RR:1.12(1.04–1.21)]. EMR was superior to hot snare polypectomy (HSP) [RR:1.04(1.00–1.08)] regarding complete resection, while underwater EMR (U-EMR) achieved significantly higher rate of en bloc resection compared to CSP [RR:1.15(1.01–1.30)]. EMR yielded the highest ranking for complete resection(SUCRA-score 0.81), followed by cold-snare EMR(CS-EMR,SUCRA-score 0.76). None of the modalities was different regarding adverse event rate compared to CSP, however EMR and CS-EMR resulted in fewer adverse events compared to HSP [RR:0.44(0.26–0.77) and 0.43(0.21–0.87),respectively].ConclusionEMR achieved the highest performance in resecting 6–20 mm nonpedunculated colorectal polyps, with this effect being consistent for polyps 6–9 and ≥10 mm; findings supported by very low quality of evidence. 相似文献
2.
Jing Wang Xiao-Hua Zhang Jian Ge Chong-Mei Yang Ji-Yong Liu Shu-Lei Zhao 《World journal of gastroenterology : WJG》2014,20(25):8282-8287
AIM: To compare the efficacy and safety of endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) for the treatment of colorectal tumors.METHODS: Databases, such as PubMed, EMBASE, Cochrane Library and Science Citation Index updated to 2013 were searched to include eligible articles. In the meta-analysis, the main outcome measurements were the en bloc resection rate, the histological resection rate and the local recurrence rate. Meanwhile, we also compared the operation time and the incidence of procedure-related complications.RESULTS: Six trials were identified and a total of 1642 lesions were included. The en bloc resection rate was higher and the local recurrence rate was lower in the ESD group compared with the EMR group (OR = 7.94; 95%CI: 3.96-15.91; OR = 0.09; 95%CI: 0.04-0.19). There was no significant difference in histological resection rate(OR = 1.65; 95%CI: 0.29-9.30) and procedure-related complication rate between the two groups (OR = 1.59; 95%CI: 0.92-2.73). The meta-analysis also showed that ESD was more time consuming than EMR.CONCLUSION: Compared with EMR, ESD results in higher en bloc resection rate and lower local recurrence rate for the treatment of colorectal tumors, without increasing the procedure-related complications. 相似文献
3.
《Digestive and liver disease》2023,55(6):714-720
Background and AimsUnderwater endoscopic mucosal resection (UEMR) is an emerging technique for endoscopic resection of superficial non-ampullary duodenal epithelial tumors (SNADETs). However, compared to conventional EMR, its efficacy and safety has not been widely explored.MethodsWe conducted a comprehensive search using the Pubmed, Embase, and Cochrane Library databases to identify studies comparing the efficacy and safety of UEMR versus EMR for SNADETs. The main outcomes examined included en bloc resection rate, R0 resection rate, recurrence rate, procedure time, and adverse events.ResultsA total of 5 studies comprising 635 patients were included. All the literature included duodenal lesions smaller than 20 mm. The pooled analysis showed that UEMR could achieve a higher en bloc resection rate (OR 1.78, 95%CI: 1.17 to 2.71, P = 0.007) and shorter procedure time (MD -4.08, 95%CI: -6.44 to -1.73, P = 0.0007) than EMR. However, the pooled results did not support a superiority of UEMR over EMR for R0 resection rate (OR 1.27; 95% CI: 0.90 to 1.81, P = 0.18) or recurrence rate (OR 0.49; 95% CI: 0.15 to 1.67, P = 0.26). The occurrence of adverse events, including postoperative bleeding, intraoperative perforation, and delayed perforation, was very low in included studies.ConclusionCompared to EMR, UEMR is an effective and safe technique for SNADETs ≤20 mm. 相似文献
4.
Hyung Hun Kim Sung Eun Kim Eun Joo Cho 《World journal of gastrointestinal endoscopy》2014,6(10):493-498
AIM: To investigate whether out-patient based endo-scopic mucosal resection(EMR) for colon polyps ≤ 10 mm is safe.METHODS: Between January 2004 and December 2012, a total of 3015 EMR cases conducted in 1320 patients were retrospectively reviewed. The factors contributing delayed hemorrhage were analyzed. We calculated the probability of delayed bleeding after stratifying conditions of specific risk factors.RESULTS: The size of the polyp(95%CI: 1.096-1.164, P 0.001) and patients with chronic renal failure(95%CI: 1.856-45.106, P = 0.007) were identified as independent risk factors for delayed bleeding in multi-variate analysis. 95%CI for percent of delayed bleedingaccording to polyp size was determined for the fol-lowing conditions: size ≤ 10 mm, 0.05%-0.43%; 20 mm ≥ size 10 mm, 0.54%-2.08%; size 20 mm, 4.22%-11.41%. 95%CI was determined for the risk of serious immediate bleeding for a polyp ≤ 10 mm was 0.10%-0.56%. Finally, 95%CI for percent of incomplete resection was 0.07%-0.49% in polyps ≤ 10 mm. CONCLUSION: It seems acceptable to perform outpa-tient-based EMR for colon polyps ≤ 10 mm. 相似文献
5.
Dengshen Zhang Xin Mao Daxing Liu Jian Zhang Gang Luo Liangliang Luo 《Clinical cardiology》2020,43(12):1414-1422
BackgroundTranscatheter aortic valve replacement (TAVR) is regarded as the most superior alternative treatment approach for patients with aortic stenosis (AS) who are associated with high surgical risk, whereas the effectiveness of TAVR vs surgical aortic valve replacement (SAVR) in low to intermediate surgical risk patients remained inconclusive. This study aimed to determine the best treatment strategies for AS with low to intermediate surgical risk based on published randomized controlled trials (RCTs).Hypothesis and MethodsRCTs that compared TAVR vs SAVR in AS patients with low to intermediate surgical risk were identified by PubMed, EmBase, and the Cochrane library from inception till April 2019. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated for the data collected using random‐effects models.ResultsSeven RCTs with a total of 6929 AS patients were enrolled. We noted that TAVR significantly increased the risk of transient ischemic attack (TIA) (RR: 1.43; 95%CI: 1.04‐1.96; P = .029), and permanent pacemaker implantation (RR: 3.00; 95%CI: 1.70‐5.30; P < .001). However, TAVR was associated with lower risk of post‐procedural bleeding (RR: 0.57; 95%CI: 0.33‐0.98; P = .042), new‐onset or worsening of atrial fibrillation (RR: 0.32; 95%CI: 0.23‐0.45; P < .001), acute kidney injury (RR: 0.40; 95%CI: 0.25‐0.63; P < .001), and cardiogenic shock (RR: 0.34; 95%CI: 0.19‐0.59; P < .001). The risk of aortic‐valve reintervention at 1‐ (RR: 2.63; 95%CI: 1.34‐5.15; P = .005), and 2 years (RR: 3.19; 95%CI: 1.63‐6.24; P = .001) in low to intermediate surgical risk patients who received TAVR was significantly increased than those who received SAVR.ConclusionsThese findings indicated that low to intermediate surgical risk patients who received TAVR had low risk of complications, whereas the risk of TIA, permanent pacemaker implantation, and aortic‐valve reintervention was increased. 相似文献
6.
Jae Yun Kim Su Jung Han Young Sin Cho Il-Kwun Chung Tae Hoon Lee 《Scandinavian journal of gastroenterology》2013,48(12):1541-1546
AbstractBackground: The factors associated with recurrence of colonic neoplasm after endoscopic resection with a positive lateral margin are not well known. Thus, we evaluate the relationship between recurrence and positive lateral margin after endoscopic en bloc resection of colorectal neoplasm.Methods: A retrospective review of 9302 patients who underwent colonic endoscopic resection from January 2008 to January 2015. Of these, a total of 76 patients with positive lateral margins with clear evidence of the its location on endoscopic picture after endoscopic en bloc resection of colorectal neoplasm (>10?mm) were included.Results: Ten of 76 (13.2%) patients experienced recurrence during the follow-up period (mean f/u month, 21.7?±?15.6). In cases with positive lateral margins, the 3- and 5-year local recurrence rate of colorectal neoplasm was 28.1% and 40.1%, respectively. The histological features of the recurrence group were as follows: one case of adenocarcinoma [from low-grade adenoma (LGA)]; two cases of high-grade adenoma (HGA) (one from HGA and one from LGA); and seven cases of LGA (four from adenocarcinoma, two from LGA, and one from HGA). The mean age of patients, locations of the lesions, and histologic type were not significantly associated with local recurrence. In multivariate Poisson regression analyses, total length of lateral margin involvement ≥8?mm (relative risk 12.51; 95% CI 1.11–140.34, p?=?.040) was a significant predictor of local recurrence.Conclusions: Positive lateral margins ≥8?mm may be a reliable predictor of local recurrence after endoscopic en bloc resection of colorectal neoplasm. 相似文献
7.
《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2023,17(1):102697
Background and aimsNo meta-analysis has analysed the safety and efficacy of lobeglitazone in type-2 diabetes (T2DM). We undertook this meta-analysis to address this knowledge-gap.MethodsElectronic databases were searched for RCTs involving type-2 diabetes patients receiving lobeglitazone in intervention arm, and placebo/active comparator in control arm. Primary outcome was to evaluate changes in HbA1c. Secondary outcomes were to evaluate alterations in glucose, lipids and adverse events.ResultsFrom initially screened 65 articles, data from 4 RCTs (828 patients) which fulfilled all criteria was analysed. Over 24 weeks, when compared to sitagliptin 100 mg/d and half maximal pioglitazone dose (15 mg/d), lobeglitazone 0.5 mg/day had comparable impact on HbA1c [MD 0.03% (95%CI: 0.11–0.17); P = 0.65; I2 = 0%], fasting glucose [MD 1.47 mg/dl (95%CI: 4.66–7.60); P = 0.64; I2 = 0%], triglycerides [MD-9.96 mg/dl (95%CI: 43.55–23.62); P = 0.56; I2 = 81%], LDL-cholesterol [MD0.74 mg/dl (95%CI: 4.60–6.09); P = 0.79; I2 = 0%] and HDL-cholesterol [MD1.55 mg/dl (95%CI: 3.72–6.82); P = 0.56]. Occurrence of treatment-emergent adverse events (AEs) [RR 1.07 (95% CI:0.78–1.47); P = 0.67; I2 = 0%] and severe AEs [RR 1.05(95%CI: 0.42–2.65); P = 0.91; I2 = 0%] were similar. Edema and weight gain were significantly higher with lobeglitazone compared to controls [RR 2.58 (95%CI: 1.08–6.17); P = 0.03; I2 = 0%]. Lobeglitazone 0.5 mg/d compared to half-maximal pioglitazone (15 mg/d), had similar edema and weight gain [RR 1.65 95% CI: 0.78–1.47)]. BMD percent changes at neck of femur was comparable in both groups [MD 0.07% (95%CI: 0.19–0.33); P = 0.60; I2 = 91%]. Low dose lobeglitazone (0.25 mg/d) was inferior to high dose lobeglitazone (0.5 mg/d) with regards to glycaemic efficacy with advantage of lower weight gain and edema.ConclusionThe current evidence makes lobeglitazone unlikely to replace pioglitazone as the preferred thiazolidinedione in T2DM. 相似文献
8.
Naohisa Yoshida Yuji Naito Yutaka Inada Munehiro Kugai Nobuaki Yagi Ken Inoue Takashi Okuda Daisuke Hasegawa Kazuyuki Kanemasa Kassai Kyoichi Kiichi Matsuyama Takashi Ando Toshiki Takemura Seiji Shimizu Naoki Wakabayashi Akio Yanagisawa Toshikazu Yoshikawa 《International journal of colorectal disease》2013,28(7):985-991
Purpose
Endoscopic mucosal resection (EMR) of colorectal polyps should be curative and safe. This study aimed to determine the efficacy and safety of colorectal EMR using 0.13 % hyaluronic acid (HA) solution.Methods
This was a single-armed multicenter prospective open trial conducted at 11 Japanese institutions. Lesion characteristics and various measures of clinical outcome, including en bloc resection, histopathologically complete resection, and postoperative bleeding were analyzed for 624 consecutive patients who underwent EMR of colorectal polyps at ≤20 mm in size from August 2010 to September 2011.Results
En bloc and complete resection were achieved in 93.3 and 78.3 % of 624 lesions. The median EMR procedure time was 2.1?±?1.5 min. The rates of postoperative bleeding and perforation were 1.1 and 0 %. The rate of en bloc resection was higher for polyps at 5–10 mm than for polyps at 11–20 mm (95.1 vs. 85.1 %; P?<?0.001) and was higher for protruding polyps than for superficial polyps (94.5 vs. 87.1 %; P?<?0.05). The rate of en bloc resection was also higher for polyps in the left-side colon than for those in the right-side colon or rectum (96.7 vs. 91.6 vs. 90.8 %; P?<?0.05). Multivariate analysis showed that polyp at 11–20 mm in size and location not on the left-side colon was significantly independent risk factors for failure of en bloc resection.Conclusion
EMR using 0.13 % HA of colorectal polyps less than 20 mm in size had high rates of en bloc and complete resection and few complications. 相似文献9.
Mingheng Liao Zexin Zhu Haichuan Wang 《Scandinavian journal of gastroenterology》2017,52(6-7):624-634
Objective: To evaluate the efficacy and safety of adjuvant transarterial chemoembolization (TACE) after curative hepatectomy in improving the survival of patients with primary hepatocellular carcinoma (HCC).Methods: MEDLINE, Embase and the Cochrane Library were searched for randomized or nonrandomized studies comparing postoperative adjuvant TACE with curative resection alone. Meta-analysis was performed after converting time-event data into a hazard ratio (HR), using an inverse diversity model.Results: Eight randomized controlled trials (RCTs) and 12 retrospective studies matched the selection criteria, thereby including 3191 patients (779 in RCT, 2412 in observational studies) for the meta-analysis. The meta-analysis showed that receiving adjuvant TACE was associated with improved overall survival (OS, ln[HR]?=?0.70, 95%CI: 0.63–0.78, p?<?.001) and recurrence-free survival (RFS, ln[HR]?=?0.69, 95%CI: 0.63–0.76, p?<?.001) after curative hepatectomies. The results of observational studies were consistent with those of RCTs. Furthermore, meta-regression was utilized to detect study-level factors associated with treatment outcome. It revealed that overall survival was similar among patients treated with various combinations of chemotherapeutic drugs. Subgroup analyses demonstrated that repeated TACE interventions do not provide a higher survival benefit compared with a single course, and patients with a single tumor or tumor size?≥5cm might stand to benefit the most from adjuvant TACE therapy.Conclusions: This meta-analysis demonstrated that postoperative adjuvant TACE could achieve higher OS and RFS than surgical resection alone. However, these results need to be validated through further high-quality clinical studies. 相似文献
10.
Objective: Endoscopic mucosal resection (EMR), including conventional EMR (c-EMR) and modified EMR (m-EMR), was applied to remove small rectal neuroendocrine tumors (NETs). We aim to evaluate treatment outcomes of endoscopic submucosal dissection (ESD), m-EMR and c-EMR for rectal NETs <16?mm.Methods: The PubMed, Cochrane Library and Elsevier Science Direct were searched to identify eligible articles. After quality assessment and data extraction, meta-analysis was performed. The main outcomes were complete resection rate, overall complication rate, procedure time and local recurrence rate.Results: Compared with c-EMR, ESD could achieve higher complete resection rate (OR?=?4.38, 95%CI: 2.43–7.91, p?0.00001) without increasing overall complication rates (OR?=?2.21, 95%CI: 0.56–8.70, p?=?0.25). However, ESD was more time-consuming than c-EMR (MD?=?6.72, 95%CI: 5.84–7.60, p?0.00001). Compared with m-EMR, ESD did not differ from m-EMR in complete resection and overall complication rates (OR?=?0.80, 95%CI: 0.51–1.27, p?=?0.34; OR?=?1.91, 95%CI: 0.75–4.86, p?=?0.18, respectively). However, ESD was more time-consuming than m-EMR (MD?=?12.21, 95%CI: 7.78–16.64, p?0.00001). Compared with c-EMR, m-EMR could achieve higher complete resection rate (OR?=?4.23, 95%CI: 2.39–7.50, p?0.00001) without increasing overall complication rate (OR?=?1.07, 95%CI: 0.35–3.32, p?=?0.90). Moreover, m-EMR was not time-consuming than c-EMR (MD?=?2.01, 95%CI: ?0.37–4.40, p=?0.10). The local recurrence rate was 0.84% (9/1067) during follow-up.Conclusions: Both ESD and m-EMR have great advantages over c-EMR in complete resection rate without increasing safety concern while m-EMR shares similar outcomes with ESD for rectal NETs <16?mm. The results should be confirmed by well-designed, multicenter, randomized controlled trials with large samples and long-term follow-ups from more countries. 相似文献
11.
Ping Li Fang Fang Jia-Xun Cai Dong Tang Qing-Guo Li Dao-Rong Wang 《World journal of gastroenterology : WJG》2013,19(47):9119-9126
AIM:To evaluate the fast-track rehabilitation protocol and laparoscopic surgery(LFT)vs conventional care strategies and laparoscopic surgery(LCC).METHODS:Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE,the Cochrane Central Register of Controlled Trials and EMBASE.The complications and re-admission after approximately 1 mo were assessed.RESULTS:Six recent randomized controlled trials(RCTs)were included in this meta-analysis,which related to 655 enrolled patients.These studies demonstrated that compared with LCC,LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo.LFT had a pooled RR of 0.60(95%CI:0.46-0.79,P<0.001)compared with a pooled RR of 0.69(95%CI:0.34-1.40,P>0.5)for LCC.CONCLUSION:LFT for colorectal malignancy is safe and efficacious.Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach. 相似文献
12.
Miguel A Tanimoto M Lourdes Guerrero Yoshinori Morita Jonathan Aguirre-Valadez Elisa Gomez Carlos Moctezuma-Velazquez Jose A Estradas-Trujillo Miguel A Valdovinos Luis F Uscanga Rikiya Fujita 《World journal of gastrointestinal endoscopy》2015,7(4):417-428
AIM: To summarize the clinical impact of a formal training for the effectiveness and safety of endoscopic submucosal dissection for gastrointestinal cancer.METHODS: We searched databases including PubM ed, EMBASE and the Cochrane Library and Science citation Index updated to August 2014 to include eligible articles. In the Meta-analysis, the main outcome measurements were en bloc resection rate, local recurrence rate(R0) and the incidence of procedure-related complications(perforation, bleeding). RESULTS: En bloc resection was high for both, dissecting stomach tumors with an overall percentage of 93.2%(95%CI: 90.5-95.8) and dissecting colorectal tumors with an overall percentage of 89.4%(95%CI: 85.1-93.7). Although the number of studies reporting R0 resection(the dissected specimen was revealed free of tumor in both vertical and lateral margins) was small, the overall estimates for R0 resection were 81.4%(95%CI: 72-90.8) for stomach and 85.9%(95%CI: 77.5-95.5) for colorectal tumors, respectively. The analysis showed that the percentage of immediate perforation and bleeding were very low; 4.96(95%CI: 3.6-6.3) and 1.4%(95%CI: 0.8-1.9) for colorectal tumors and 3.1%(95%CI: 2.0-4.1) and 4.8%(95%CI: 2.8-6.7) for stomach tumors, respectively. CONCLUSION: In order to obtain the same rate of success of the analyzed studies it is a necessity to create training centers in the western countries during the "several years" of gastroenterology residence first only to teach EGC diagnose and second only to train endoscopic submucosal dissection. 相似文献
13.
Yu-Long Cai Xian-Ze Xiong Si-Jia Wu Yao Cheng Jiong Lu Jie Zhang Yi-Xin Lin Nan-Sheng Cheng 《World journal of gastroenterology : WJG》2013,19(31):5165-5173
AIM: To assess the differences in clinical benefits and disadvantages of single-incision laparoscopic appendectomy(SILA) and conventional laparoscopic appendectomy(CLA).METHODS: The Cochrane Library,MEDLINE,Embase,Science Citation Index Expanded,and Chinese Biomedical Literature Database were electronically searched up through January 2013 to identify randomized controlled trails(RCTs) comparing SILA with CLA.Data was extracted from eligible studies to evaluate the pooled outcome effects for the total of 1068 patients.The meta-analysis was performed using Review Manager 5.2.0.For dichotomous data and continuous data,the risk ratio(RR) and the mean difference(MD) were calculated,respectively,with 95%CI for both.For continuous outcomes with different measurement scales in different RCTs,the standardized mean difference(SMD) was calculated with 95%CI.Sensitivity and subgroup analyses were performed when necessary.RESULTS: Six RCTs were identified that compared SILA(n = 535) with CLA(n = 533).Five RCTs had a high risk of bias and one RCT had a low risk of bias.SILA was associated with longer operative time(MD = 5.68,95%CI: 3.91-7.46,P < 0.00001),higher conversion rate(RR = 5.14,95%CI: 1.25-21.10,P = 0.03) and better cosmetic satisfaction score(MD = 0.52,95%CI: 0.30-0.73,P < 0.00001) compared with CLA.No significant differences were found for total complications(RR = 1.15,95%CI: 0.76-1.75,P = 0.51),drain insertion(RR = 0.72,95%CI: 0.41-1.25,P = 0.24),or length of hospital stay(SMD = 0.04,95%CI:-0.08-0.16,P = 0.57).Because there was not enough data among the analyzed RCTs,postoperative pain was not calculated.CONCLUSION: The benefit of SILA is cosmetic satisfaction,while the disadvantages of SILA are longer operative time and higher conversion rate. 相似文献
14.
《Expert Review of Gastroenterology & Hepatology》2013,7(5):521-531
Endoscopic mucosal resection (EMR) with curative intent has evolved into a safe and effective technique and is currently the gold standard for management of large colonic epithelial neoplasms. Piecemeal EMR is associated with a high risk of local recurrence requiring vigilant surveillance and repeat interventions. Endoscopic submucosal dissection (ESD) was introduced in Japan for the management of early gastric cancer, and has recently been described for en bloc resection of colonic lesions greater than 20 mm. En bloc resection allows accurate histological assessment of the depth of invasion, minimizes the risk of local recurrence and helps determine additional therapy. Morphologic classification of lesions prior to resection allows prediction of depth of invasion and risk of nodal metastasis, allowing selection of the appropriate intervention. This review provides an overview of the assessment of epithelial neoplasms of the colon and the application of EMR and ESD techniques in their management. 相似文献
15.
《HPB : the official journal of the International Hepato Pancreato Biliary Association》2019,21(12):1613-1620
BackgroundRecent randomized controlled trials (RCTs) reported conflicting results regarding the safety of laparoscopic pancreaticoduodenectomy (LPD). The aim of this study was to perform a meta-analysis of the available RCTs concerning the short-term outcomes of LPD versus open pancreaticoduodenectomy (OPD).MethodsThe Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), EMBASE, Scopus databases and ClinicalTrials.gov register were searched. Only RCTs published up to February 2019 were eligible for inclusion. Random-effect models were used to summarize the relative risks (RR) and mean differences.Results3 RCTs were identified, including a total number of 114 and 110 patients who underwent LPD and OPD, respectively. The rate of major postoperative complications (Clavien-Dindo ≥3) was 29% in LPD vs 31% in OPD group (RR 0.80 (95% CI: 0.36–1.79); p = 0.592). Complication-related mortality occurred in 5% (LPD) vs 4% (OPD) patients (RR 1.22 (95% CI: 0.19–8.02); p = 0.841). LPD was significantly associated with longer operative time [95 min (95% CI: 24–167; p = 0.009)] and lower perioperative blood loss [−151 ml (95% CI: 169–133; p < 0.001)].ConclusionsThere are no statistically significant differences between LPD and OPD in terms of postoperative complications and mortality. However, these findings should be interpreted with caution due to high clinical and statistical heterogeneity of pooled data. Further studies with different outcome measures are needed to clarify the future of LPD. 相似文献
16.
《Digestive and liver disease》2020,52(12):1445-1454
ObjectiveTo investigate the overall performance of carbon nanoparticles (CNs) for detecting lymph nodes (LNs) and node metastasis during colorectal cancer surgery.MethodsThe English and Chinese literature was searched until 29 April 2020. Studies were included if they were randomized controlled trials (RCTs) for colorectal resection and LN dissection that compared the use of CNs with a blank control in colorectal cancer surgery. Quality assessment and data extraction were performed, and a meta-analysis was conducted using ReviewManager 5.3 and Stata 15.1 software.ResultsA total of 17 RCTs comprising 1241 patients were included for analysis. Compared with the outcomes of the blank controls, the use of CNs resulted in an average of 5.21 more LNs per patient (weighted mean difference = 5.21, 95% confidence interval [CI] = 4.14–6.29, p < 0.001) and a 68% higher detection rate of micro LNs (relative risk [RR] = 1.68, 95% CI = 1.38–2.04, p < 0.001). In addition, more metastatic LNs were identified in stained nodes (RR = 1.56, 95% CI = 1.40–1.75, p < 0.001), but the total detection rate of metastatic nodes did not differ between the groups.ConclusionCN is an effective lymphatic tracer in colorectal cancer surgeries. Further studies with larger sample sizes are needed to validate these findings. 相似文献
17.
Ahmed Twaij Philip H Pucher Mikael H Sodergren Tamara Gall Ara Darzi Long R Jiao 《World journal of gastroenterology : WJG》2014,20(25):8274-8281
AIM: To review the currently available literature comparing laparoscopic to open resection of hepatocellular carcinoma (HCC) in patients with known liver cirrhosis.METHODS: A literature search of MEDLINE, EMBASE, and Cochrane databases was conducted. The search terms used included (laparoscopic OR laparoscopy) AND (hepatic or liver) AND (surgery or resection) AND “hepatocellular carcinoma” AND (cirrhosis or cirrhotic). Furthermore, to widen the search, we also used the “related articles” section. Studies reporting a comparison of outcomes and methods of open vs laparoscopic hepatic resection for HCC in patients with liver cirrhosis were included. Meta-analysis of results was performed using a random effects model to compute relative risk (RR) and for dichotomous variables and standard mean differences (SMD) for continuous variables.RESULTS: A total of 420 patients from 4 cohort studies were included in final analysis. Patients undergoing laparoscopic procedures had statistically less blood loss compared to the open cohort, SMD of -1.01 (95%CI: -1.23-0.79), P < 0.001, with a reduced risk of transfusion, RR = 0.19 (95%CI: 0.09-0.38), P < 0.001. A wider clearance at tumour resection margins was achieved following a laparoscopic approach, SMD of 0.34 (95%CI: 0.08-0.60), P = 0.011. No significant difference was noted between laparoscopic and open resection operative times, SMD of -0.15 (95%CI: 0.35-0.05), P = 0.142. The overall RR of suffering from postoperative morbidity is 0.25 in favour of the open surgery cohort (95%CI: 0.17-0.37), P < 0.001. Patients under-going laparoscopic surgery had significantly shorter length of stays in hospital compared to the open cohort, SMD of -0.53 (95%CI: -0.73 to -0.32), P < 0.001.CONCLUSION: This review suggests that laparoscopic resection of hepatocellular carcinoma in patients with cirrhosis is safe and may provide improved patient outcomes when compared to the open technique. 相似文献
18.
Hayder A. Al-Domi Ahmad Faqih Ziad Jaradat Anfal AL-Dalaeen Saied Jaradat Batool Amarneh 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2019,13(1):189-194
ObjectiveTo identify certain risk factors associated with childhood obesity related to lifestyle; dietary patterns, physical activity, and sedentary behavior.MethodsA cross-sectional study was conducted among 977 schoolchildren (473 boys and 449 girls) aged 7–18 years. Children were selected randomly from three main cities in Jordan: Amman, Irbid, and Mafraq by using multistage cluster sampling method. Sedentary behaviors, physical activity and child eating behaviors were measured by using validated questionnaires. Overweight and obesity were defined by International Obesity Task Force (IOTF) criteria.ResultsSedentary activities increase the risk of overweight among schoolchildren by 2-fold [RR(Relative risk) = 2.0, 95% CI(Confidence interval) (1.1–3.6), p = 0.02]. Whereas, sedentary activities for less than 3 h increased the risk of overweight by 0.8-fold [RR = 0.8, 95%CI (0.6–1.3), P = 0.388], Schoolchildren who spent<30 min/day in exercising decreased the risk of overweight by 0.5-fold [RR = 0.5, 95% CI (0.2–1.0), P = 0.06)]. Both Students who ate one meal daily and daily ate snacks from schools cafeterias had a higher tendency to be obese [(RR = 1.8, 95%CI (0.5–5.9), P = 0.368], and [RR = 1.5, 95%CI (0.9–2.5), P = 0.169] respectively.ConclusionsPhysical activity, eating meals regularly and homemade food, all together play a significant role in decreasing obesity among Jordanian schoolchildren, thus a national policy that promoting active living and healthy eating among schoolchildren is warranted. 相似文献
19.
《Seminars in arthritis and rheumatism》2021,51(5):1045-1056
BackgroundKawasaki disease (KD) is a form of self-limiting vasculitis that causes coronary artery abnormalities in children. Although clinical trials of monoclonal antibodies and anti-cytokine biologics that block cytokine cascades have been conducted, the studies have revealed contradictory results. To examine the effectiveness of treatment with monoclonal antibodies and anti-cytokine biologics for KD patients, we conducted this systematic review and meta-analysis.MethodsRelevant randomized controlled trials (RCTs) and observational studies (e.g., cohort studies, case-control studies, case-series, and case-reports) were included to summarize available evidence, both qualitatively and quantitatively. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and ICUSHI were used for systematic research. Meta-analysis of the included studies was conducted using fixed-effect or random-effects models, depending on the degree of between-study heterogeneity. We assessed coronary artery and treatment outcomes of the interventions. The certainty of evidence and risk of bias were assessed using the GRADE and Cochrane risk of bias tool. The protocol of this review is registered with PROSPERO (CRD42016033079).ResultsResults: Of all searched studies, 183 studies were qualitatively analyzed. We finally included four randomized controlled trials with 456 patients in quantitative syntheses. Monoclonal antibodies and anti-cytokine biologics did not reduce the frequency of CAA (risk ratio [RR], 0.93; 95% confidence interval [95%CI], 0.65 to 1.32, low certainty of evidence), compared with the conventional treatment with IVIG. However, the frequency of treatment resistance (RR, 0.60; 95%CI, 0.38 to 0.95, moderate certainty of evidence) was reduced by the antibodies. We found no statistical differences in either “any adverse event” (RR, 0.92; 95%CI, 0.80 to 1.06, low certainty of evidence) or “adverse events attributable to the administration of the medication” (RR, 1.10; 95%CI, 0.72 to 1.69, low certainty of evidence) between the two groups.ConclusionConclusions: Although monoclonal antibodies and anti-cytokine biologics were not effective in reducing the frequency of CAA in KD patients, the frequency of treatment resistance might be reduced by those agents compared with conventional IVIG therapy alone. 相似文献
20.
Antonio Facciorusso Matteo Antonino Marianna Di Maso Nicola Muscatiello 《World journal of gastrointestinal endoscopy》2014,6(11):555-563
AIM: To compare endoscopic submucosal dissection(ESD) and endoscopic mucosal resection(EMR) for early gastric cancer(EGC).METHODS: Computerized bibliographic search was performed on PubMed/Medline, Embase, Google Schol-ar and Cochrane library databases. Quality of each included study was assessed according to current Co-chrane guidelines. Primary endpoints were en bloc re-section rate and histologically complete resection rate. Secondary endpoints were length of procedure, post-treatment bleeding, post-procedural perforation and re-currence rate. Comparisons between the two treatment groups across all the included studies were performed by using Mantel-Haenszel test for fixed-effects mod-els(in case of low heterogeneity) or DerSimonian and Laird test for random-effects models(in case of high heterogeneity).RESULTS: Ten retrospective studies(8 full text and 2 abstracts) were included in the meta-analysis. Overall data on 4328 lesions, 1916 in the ESD and 2412 in the EMR group were pooled and analyzed. The mean operation time was longer for ESD than for EMR(stan-dardized mean difference 1.73, 95%CI: 0.52-2.95, P =0.005) and the "en bloc " and histological complete re-section rates were significantly higher in the ESD group [OR = 9.69(95%CI: 7.74-12.13), P 0.001 and OR = 5.66,(95%CI: 2.92-10.96), P 0.001, respectively]. As a consequence of its greater radicality, ESD provided lower recurrence rate [OR = 0.09,(95%CI: 0.05-0.17), P 0.001]. Among complications, perforation rate was significantly higher after ESD [OR = 4.67,(95%CI, 2.77-7.87), P 0.001] whereas the bleeding incidences did not differ between the two techniques [OR = 1.49(0.6-3.71), P = 0.39].CONCLUSION: In the endoscopic therapy of EGC, ESD showed a superior efficacy but higher complication rate with respect to EMR. 相似文献