Diverticular per oral endoscopic myotomy (DPOEM) for esophageal diverticular disease: a systematic review and meta-analysis

The traditional way to tackle Zenker’s diverticulum (ZD) has been flexible endoscopic septum division (FESD). Recently, the concept of per oral endoscopic myotomy has been found useful for managing diverticular diseases of the esophagus and has been termed DPOEM. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of D-POEM in diverticular disease of the esophagus and to compare it with FESD. We systematically searched PubMed and Embase, for studies reporting clinical success, technical success and adverse events in D-POEM alone or D-POEM comparing with FESD. We computed pooled prevalence for D-POEM alone and risk ratio for D-POEM vs FESD using random effect method with inverse variance approach. Subgroup analysis for ZD, non-ZD and mixed diverticulum was conducted. Totally 19 studies including 341 patients were identified reporting on D-POEM. The pooled clinical, technical success and adverse event rates for D-POEM were 87.07%, 95.19% and 10.22%, respectively. The clinical success was significantly better than FESD while the technical success, adverse event rate, procedure time and length of hospital stay were comparable with FESD. The recurrence rate was negligible for D-POEM compared to FESD. On subgroup analysis by dividing into three groups of ZD, non-ZD and mixed, there was no difference between clinical, technical success and adverse event rate among the three groups. D-POEM is an effective and safe technique among both ZD and non-ZD patients and has better clinical success than FESD.

     

Use of semithin sections for the preliminary evaluation of the granularity of epithelial cells in the human juxtaglomerular apparatus

As the evaluation of granularity of the juxtaglomerular apparatus (JGA) by Hartroft method in preparations stained according to Bowie is difficult due to a small size of kidney biopsies and the necessity ot use light microscopy, immunohistochemical method, and electron microscopy for examination of each biopsy, we investigated semi-thin araldite sections (STS) about 1-2 micrometer thick for preliminary evaluation of JGA epithelioid cell granularity. Three most widely used methods for STS staining modified by us were employed: toluidine blue without resin removal, methylene blue-azur II-fuchsin, Schiff reagent with resin removal. The staining results were as follows: toluidine blue stains granules in epithelioid cells violet, methylene blue-azur II-fuchsin blue, and Schiff reagent red. All the three methods allow detection and counting of the granules in JGA epithelioid cells. The best results were obtained with PAS-reaction when the granules are stained red against the pink background and lie separately from each other. Apart from the evaluation of JGA granularity, three-color staining and toluidine blue allow light microscopy study of other renal structures. For practical purposes, toluidine blue staining of STS is most convenient giving rapidly preparations of a rather good quality. Electron microscopy detects more granules than in STS, and permits their verification (rhomboid protogranules, spherical and lipofuscin-like granules.