Endoscopic and surgical drainage for pancreatic fluid collections are better than percutaneous drainage: Meta-analysis

BackgroundPancreatic pseudocyst (PP) and walled-off necrosis can be managed endoscopically, percutaneously or surgically, but with diverse efficacy.Aims & methodsA comprehensive literature search was carried out from inception to December 2018, to identify articles which compared at least two of the three kinds of treatment modalities, regarding the mortality, clinical success, recurrence, complications, cost and length of hospitalisation (LOH).ResultsThe outcomes of endoscopic (ED) and percutaneous drainage (PD) were comparable in six articles. The clinical success of endoscopic intervention was better considering any types of fluid collections (OR = 3.36; 95% confidence interval (CI) 1.48, 7.63; p = 0.004). ED was preferable regarding recurrence of PP (OR = 0.23; 95% CI 0.08, 0.66; p = 0.006). Fifteen articles compared surgical intervention with ED. Significant difference was found in postoperative LOH (WMD (days) = −4.61; 95%CI -7.89, −1.33; p = 0.006) and total LOH (WMD (days) = −3.67; 95%CI -5.00, −2.34; p < 0.001) which favored endoscopy, but ED had lower rate of clinical success (OR = 0.54; 95% CI 0.35, 0.85; p = 0.007) and higher rate of recurrence (OR = 1.80; 95% CI 1.16, 2.79; p = 0.009) in the treatment of PP. Eleven studies compared surgical and percutaneous intervention. PD resulted in higher rate of recurrence (OR = 4.91; 95% CI 1.82, 13.22; p = 0.002) and lower rate of clinical success (OR = 0.13; 95% CI 0.07, 0.22, p < 0.001).ConclusionBoth endoscopy and surgery are preferable over percutaneous intervention, furthermore endoscopic treatment is associated with shorter hospitalisation than surgery.     

Real-world clinical data of endoscopy-based cancer detection during the emergency declaration for COVID-19 in Japan

The impact of the coronavirus disease 2019(COVID-19) pandemic is widespread throughout the world, causing serious damage to healthcare systems. Therefore, we examined the significance of endoscopy based on the recommendation of Asian-Pacific Society for Digestive Endoscopy and Japan Gastroenterological Endoscopy Society during the COVID-19 pandemic by evaluating the details of gastrointestinal endoscopy performed during the declaration of emergency in Japan. We have continued performing gastrointestinal endoscopy at an outpatient clinic that specialized in endoscopic medical care in Tokyo, Japan. During the emergency declaration period, 544 patients underwent gastrointestinal endoscopy. As a control, we investigated 1327 patients who underwent gastrointestinal endoscopy during the same period in 2019. Although the total number of endoscopies during the emergency declaration was halved, the advanced cancer detection rate during the emergency declaration was significantly higher than that in 2019(P = 0.04). Additionally, no COVID-19 infection was observed in healthcare workers, staff, or patients during this period. It is possible that an outpatient endoscopy units can contribute to the detection of advanced cancer, while the hospital in charge for patients with COVID-19 infection could not perform endoscopy during the declaration of emergency.     

A simplified clinical risk score predicts the need for early endoscopy in non-variceal upper gastrointestinal bleeding

BackgroundPre-endoscopic triage of patients who require an early upper endoscopy can improve management of patients with non-variceal upper gastrointestinal bleeding.AimsTo validate a new simplified clinical score (T-score) to assess the need of an early upper endoscopy in non variceal bleeding patients. Secondary outcomes were re-bleeding rate, 30-day bleeding-related mortality.MethodsIn this prospective, multicentre study patients with bleeding who underwent upper endoscopy were enrolled. The accuracy for high risk endoscopic stigmata of the T-score was compared with that of the Glasgow Blatchford risk score.ResultsOverall, 602 patients underwent early upper endoscopy, and 472 presented with non-variceal bleeding. High risk endoscopic stigmata were detected in 145 (30.7%) cases. T-score sensitivity and specificity for high risk endoscopic stigmata and bleeding-related mortality was 96% and 30%, and 80% and 71%, respectively. No statistically difference in predicting high risk endoscopic stigmata between T-score and Glasgow Blatchford risk score was observed (ROC curve: 0.72 vs. 0.69, p = 0.11). The two scores were also similar in predicting re-bleeding (ROC curve: 0.64 vs. 0.63, p = 0.4) and 30-day bleeding-related mortality (ROC curve: 0.78 vs. 0.76, p = 0.3).ConclusionsThe T-score appeared to predict high risk endoscopic stigmata, re-bleeding and mortality with similar accuracy to Glasgow Blatchford risk score. Such a score may be helpful for the prediction of high-risk patients who need a very early therapeutic endoscopy.     

Oesophageal capsule endoscopy versus oesophago-gastroduodenoscopy for the diagnosis of recurrent varices: A prospective multicentre study

BackgroundOesophago-gastroduodenoscopy is the standard method for the diagnosis of recurrent oesophago-gastric varices after endoscopic treatment and eradication. The aim of this study was to evaluate the PillCam^®Eso capsule endoscopy in this setting.MethodsProspective, multicentre study in which patients with history of oesophageal varices treated by band ligation underwent PillCam^®Eso capsule and oesophago-gastroduodenoscopy. Capsule recordings were blindly read by two endoscopists. Indication for a new prophylactic treatment and patient satisfaction were determined for both procedures.Results80 patients (80% males, mean age: 57 ± 12 years) were included, after a median delay of 16 months from last endoscopic treatment. Recurrent oesophageal varices requiring a new prophylactic treatment were detected in 26 patients (32.5%). The mean oesophageal transit time of the capsule was 153 s (range 2–930 s). Capsule sensitivity, specificity, negative and positive predictive values for indication of new prophylactic treatments were 65%, 83%, 83%, and 65%, respectively. Capsule adequately classified 77.5% of the patients for prophylaxis indication. Inter-observer concordance for capsule readings was 88% for the prophylaxis indication.ConclusionThis study demonstrates that accuracy of PillCam^®Eso capsule for the diagnosis of recurrent oesophageal varices after endoscopic eradication is suboptimal. PillCam^®Eso capsule might therefore be proposed in patients unable or unwilling to undergo oesophago-gastroduodenoscopy.