Clinical Endoscopy

Acute Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review and Meta-Analysis: Umair Iqbal, Hafsa Anwar, Hafiz Umair Siddiqui, Muhammad Ali Khan, Faisal Kamal, Bradley D. Confer, Harshit S. Khara; Clin Endosc 2021;54(4):534-541. Published online June 25, 2021; DOI: https://doi.org/10.5946/ce.2021.071

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Background
/Aims: More than 100 million people to date have been affected by the coronavirus disease-2019 (COVID-19) pandemic. Patients with COVID-19 have a higher risk of bleeding complications. We performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 patients with signs and symptoms of acute gastrointestinal bleeding (GIB).
Methods
A systematic literature search was carried out for articles published until until November 11, 2020, in the Embase, MEDLINE, Web of Science, and Cochrane Library databases. We included studies on COVID-19 patients with signs and symptoms of GIB.
Results
Our search yielded 49 studies, of which eight with a collective 127 patients (86 males and 41 females) met our inclusion criteria. Conservative management alone was performed in 59% of the patients, endoscopic evaluation in 31.5%, and interventional radiology (IR) embolization in 11%. Peptic ulcer disease was the most common endoscopic finding, diagnosed in 47.5% of the patients. Pooled overall mortality was 19.1% (95% confidence interval [CI]; 12.7%-27.6%) and pooled mortality secondary to GIB was 3.5% (95% CI; 1.3%–9.1%). The pooled risk of rebleeding was 11.3% (95% CI; 6.8%–18.4%).
Conclusions
The majority of COVID-19 patients with GIB responded to conservative management, with a low mortality rate associated with GIB and the risk of rebleeding. Thus, we suggest limiting endoscopic and IR interventions to those with hemodynamic instability and those for whom conservative management was unsuccessful.

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Prevalence and outcomes of upper gastrointestinal bleeding in COVID‐19: A systematic review and meta‐analysis
Sawai Singh Rathore, Zario Shai Wint, Aman Goyal, Bijay Mukesh Jeswani, Ameer Mustafa Farrukh, María Alejandra Nieto‐Salazar, Thanmai Reddy Thugu, Snigdha Erva, Raafay Mehmood, Adriana Carolina Toro‐velandia, Hamam Aneis, Sunny Ratnani, Ibrahim Marouf Yas
Reviews in Medical Virology.2024;[Epub] CrossRef
Inpatient outcomes of inflammatory bowel disease in hospitalized patients with COVID-19: analysis of a nationally representative sample
Mohammad Aldiabat, Saqr Alsakarneh, Tyrell Daniel, Muhammad Ali Butt, Balaji Jagdish, James Rock, Aarushi Sudan, Majd Al-Ahmad, Ahmad Jabri, Yassine Kilani, Tarek Odah, Laith Alhuneafat, Mir Zulqarnain, Jana G. Hashash, Hassan Ghoz
Baylor University Medical Center Proceedings.2024; 37(2): 239. CrossRef
Rates, Risk Factors, and Outcomes of Nonvariceal Upper Gastrointestinal Bleeding in Patients Hospitalized for COVID-19 in the United States
Mohammad Aldiabat, Wesam Aleyadeh, Taimur Muzammil, Kemi Adewuyi, Majd Alahmad, Ahmad Jabri, Laith Alhuneafat, Yassine Kilani, Saqr Alsakarneh, Mohammad Bilal
Current Medical Science.2024; 44(6): 1202. CrossRef
Increasing inpatient mortality of nonvariceal upper gastrointestinal bleeding during the COVID-19 pandemic: a nationwide retrospective cohort study
Waqas Rasheed, Gnanashree Dharmarpandi, Ola Al-Jobory, Anass Dweik, Muhammad Anil, Sameer Islam
Baylor University Medical Center Proceedings.2023; 36(3): 286. CrossRef
Outcomes in Patients Admitted for Upper Gastrointestinal Bleeding and COVID-19 Infection: A Study of Two Years of the Pandemic
Sergiu Cazacu, Daniela Burtea, Vlad Iovănescu, Dan Florescu, Sevastița Iordache, Adina Turcu-Stiolica, Victor Sacerdotianu, Bogdan Ungureanu
Life.2023; 13(4): 890. CrossRef
Prevalence, causes, medical interventions, and mortality outcome of acute gastrointestinal bleeding among COVID-19 inpatients
Mai N. Luu, Thinh P. Dang, Minh-Cong H. Vo, Duc T. Quach
Current Medical Research and Opinion.2023; 39(5): 731. CrossRef
Gastrointestinal Bleeding in Patients With New Coronavirus Infection COVID-19
V. D. Anosov, S. A. Domrachev, S. V. Ovchinnikov, N. O. Solovyov
Russian Sklifosovsky Journal "Emergency Medical Care".2023; 12(3): 458. CrossRef
Clinical and Endoscopic Outcomes in COVID-19 Patients With Gastrointestinal Bleeding
Hassan Ashktorab, Tiziano Russo, Gholamreza Oskrochi, Giovanni Latella, Sara Massironi, Martina Luca, Lakshmi G. Chirumamilla, Adeyinka O. Laiyemo, Hassan Brim
Gastro Hep Advances.2022; 1(4): 487. CrossRef
Clinical Characteristics of Hospitalized COVID-19 Patients Who Have Gastrointestinal Bleeds Requiring Intervention: A Case-Control Study
Ahmad Abulawi, Ali Al-Tarbsheh, Annie Leamon, Paul Feustel, Amit Chopra, Asra Batool
Cureus.2022;[Epub] CrossRef
Clinical features of thrombosis and bleeding in COVID-19
Mari R. Thomas, Marie Scully
Blood.2022; 140(3): 184. CrossRef
Mortality Rate in Upper Gastrointestinal Bleeding Associated with Anti-Thrombotic Therapy Before and During Covid-19 Pandemic
Petrica Popa, Sevastita Iordache, Dan Nicolae Florescu, Vlad Florin Iovanescu, Alexandru Vieru, Valentin Barbu, Maria-Cristina Bezna, Dragos Ovidiu Alexandru, Bogdan Silviu Ungureanu, Sergiu Marian Cazacu
Journal of Multidisciplinary Healthcare.2022; Volume 15: 2679. CrossRef
Coronavirus Disease in the Abdomen
Mark A. Anderson, Mark A. Khauli, Reece J. Goiffon, Avinash Kambadakone
Advances in Clinical Radiology.2022; 4(1): 25. CrossRef
Сauses, risk factors, diagnostics and treatment of gastrointestinal bleeding in patients with a novel coronavirus infection (COVID-19)
A. A. Sheptulin, S. S. Kardasheva, A. A. Kurbatova
Clinical Medicine (Russian Journal).2022; 100(7-8): 341. CrossRef
The frequency of ulcerative-erosive defects and ulcerative bleeding of the gastroduodenal zone in patients with coronavirus infection COVID-19
N. N. Butorin, V. V. Tsukanov, R. V. Asyayev, M. N. Butorina, A. V. Vasyutin, J. L. Tonkikh
Experimental and Clinical Gastroenterology.2022; (5): 5. CrossRef

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Underwater Endoscopic Mucosal Resection for 10 mm or Larger Nonpedunculated Colorectal Polyps: A Systematic Review and Meta-Analysis: Rajat Garg, Amandeep Singh, Manik Aggarwal, Jaideep Bhalla, Babu P. Mohan, Carol Burke, Tarun Rustagi, Prabhleen Chahal; Clin Endosc 2021;54(3):379-389. Published online April 29, 2021; DOI: https://doi.org/10.5946/ce.2020.276

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Background
/Aims: Recent studies have reported the favorable outcomes of underwater endoscopic mucosal resection (UEMR) for colorectal polyps. We performed a systematic review and meta-analysis evaluating the efficacy and safety of UEMR for nonpedunculated polyps ≥10 mm.
Methods
We performed a comprehensive search of multiple databases (through May 2020) to identify studies reporting the outcomes of UEMR for ≥10 mm nonpedunculated colorectal polyps. The assessed outcomes were recurrence rate on the first follow-up, en bloc resection, incomplete resection, and adverse events after UEMR.
Results
A total of 1276 polyps from 16 articles were included in our study. The recurrence rate was 7.3% (95% confidence interval [CI], 4.3–12) and 5.9% (95% CI, 3.6–9.4) for nonpedunculated polyps ≥10 and ≥20 mm, respectively. For nonpedunculated polyps ≥10 mm, the en bloc resection, R0 resection, and incomplete resection rates were 57.7% (95% CI, 42.4–71.6), 58.9% (95% CI, 42.4–73.6), and 1.5% (95% CI, 0.8–2.6), respectively. The rates of pooled adverse events, intraprocedural bleeding, and delayed bleeding were 7.0%, 5.4%, and 2.9%, respectively. The rate of perforation and postpolypectomy syndrome was 0.8%.
Conclusions
Our systematic review and meta-analysis demonstrates that UEMR for nonpedunculated colorectal polyps ≥10 mm is safe and effective with a low rate of recurrence.

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Endoscopic Resection for Superficial Non-Ampullary Duodenal Epithelial Tumors
Hye Kyung Jeon, Gwang Ha Kim
Gut and Liver.2025; 19(1): 19. CrossRef
Water-assisted colonoscopy in inflammatory bowel diseases: From technical implications to diagnostic and therapeutic potentials
Raffaele Pellegrino, Giovanna Palladino, Michele Izzo, Ilaria De Costanzo, Fabio Landa, Alessandro Federico, Antonietta Gerarda Gravina
World Journal of Gastrointestinal Endoscopy.2024; 16(12): 647. CrossRef
Underwater Versus Conventional Endoscopic Mucosal Resection for Colorectal Laterally Spreading Tumors: A Post Hoc Analysis of Efficacy
Quang Dinh Le, Nhan Quang Le, Duc Trong Quach
JGH Open.2024;[Epub] CrossRef
Polypectomy Techniques for Pedunculated and Nonpedunculated Polyps
Karl Kwok, Sasan Mosadeghi, Daniel Lew
Techniques and Innovations in Gastrointestinal Endoscopy.2023; 25(4): 361. CrossRef
Underwater versus conventional endoscopic mucosal resection for colorectal lesions: a systematic review and meta-analysis of randomized clinical trials
Matheus Henrique Gonçalves de Souza, Paula Arruda do Espirito Santo, Fauze Maluf-Filho, Luciano Lenz
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Endoscopic treatment of colorectal polyps and early colorectal cancer
Yunho Jung
Journal of the Korean Medical Association.2023; 66(11): 642. CrossRef
EMR and ESD: Indications, techniques and results
Mamoon Ur Rashid, Mohammad Alomari, Sadaf Afraz, Tolga Erim
Surgical Oncology.2022; 43: 101742. CrossRef
Safety and effectiveness of underwater cold snare resection without submucosal injection of large non-pedunculated colorectal lesions
Andrew W. Yen, Joseph W. Leung, Malcom Koo, Felix W. Leung
Endoscopy International Open.2022; 10(06): E791. CrossRef
Underwater or conventional endoscopic mucosal resection for intermediate‐sized colorectal neoplasm?
Li‐Chun Chang
Advances in Digestive Medicine.2021; 8(3): 133. CrossRef

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Insufflation of Carbon Dioxide versus Air During Colonoscopy Among Pediatric Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: John Alexander Lata Guacho, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Bruna Furia Buzetti Hourneaux de Moura, Megui Marilia Mansilla Gallegos, Thomas McCarty, Ricardo Katsuya Toma, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(2):242-249. Published online March 25, 2021; DOI: https://doi.org/10.5946/ce.2020.275

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Background
/Aims: Carbon dioxide is increasingly used in insufflation during colonoscopy in adult patients; however, air insufflation remains the primary practice among pediatric gastroenterologists. This systematic review and meta-analysis aims to evaluate insufflation using CO₂ versus air in colonoscopies in pediatric patients.
Methods
Individualized search strategies were performed using MEDLINE, Cochrane Library, EMBASE, and LILACS databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane working methodology. Randomized control trials (RCTs) were selected for the present meta-analysis. Pooled proportions were calculated for outcomes including procedure time and abdominal pain immediately and 24 hours post-procedure.
Results
The initial search yielded 644 records, of which five RCTs with a total of 358 patients (CO₂: n=178 versus air: n=180) were included in the final analysis. The procedure time was not different between the CO₂ and air insufflation groups (mean difference, 10.84; 95% confidence interval [CI], -2.55 to 24.22; p=0.11). Abdominal pain immediately post-procedure was significantly lower in the CO₂ group (risk difference, -0.15; 95% CI; -0.26 to -0.03; p=0.01) while abdominal pain at 24 hours post-procedure was similar (risk difference, -0.05; 95% CI; -0.11 to 0.01; p=0.11).
Conclusions
Based on this systematic review and meta-analysis of RCT data, CO₂ insufflation reduced abdominal pain immediately following the procedure, while pain was similar at 24 hours post-procedure. These results suggest that CO₂ is a preferred insufflation technique when performing colonoscopy in pediatric patients.

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Gel immersion in endoscopy: Exploring potential applications
Hiroki Sato, Hidemasa Kawabata, Mikihiro Fujiya
World Journal of Gastroenterology.2025;[Epub] CrossRef
Elevations in End-Tidal CO2 With CO2 Use During Pediatric Endoscopy With Airway Protection: Is This Physiologically Significant?
Chinenye R. Dike, Andrew Huang Pacheco, Elizabeth Lyden, David Freestone, Ojasvini Choudhry, Warren P. Bishop, Mohanad Shukry
Journal of Pediatric Gastroenterology & Nutrition.2023; 76(5): 660. CrossRef

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The Role of Needle-Based Confocal Laser Endomicroscopy in the Evaluation of Pancreatic Cystic Lesions: A Systematic Review: Yung Ka Chin, Clement Chun Ho Wu, Damien Meng Yew Tan; Clin Endosc 2021;54(1):38-47. Published online March 31, 2020; DOI: https://doi.org/10.5946/ce.2019.200-IDEN

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The prevalence of pancreatic cystic lesions (PCLs) has increased recently due to the increased use of cross-sectional abdominal imaging and the ageing global population. Current diagnostic techniques are inadequate to distinguish between PCLs that require surgery, close surveillance, or expectant management. This has resulted in increased morbidity from both inappropriately aggressive and conservative management strategies. Needle-based confocal laser endomicroscopy (nCLE) has allowed microscopic examination and visual delineation of the surface epithelium of PCLs. Landmark studies in this decade have correlated nCLE and histological findings and identified characteristics differentiating various types of PCLs. Subsequent studies have confirmed the high diagnostic yield of nCLE and its diagnostic utility in PCLs with an equivocal diagnosis. Moreover, nCLE has been shown to improve the diagnostic yield of PCLs. This will help avoid unnecessary pancreatic surgery, which carries significant morbidity and mortality risks. The early detection of high-grade dysplasia in PCLs will provide early surgical treatment and improve outcomes for pancreatic cancer. Despite the high upfront cost of nCLE, the improved diagnostic accuracy and resultant appropriate management have resulted in improved cost effectiveness. Refining the procedure technique and limiting the procedure length have significantly improved the safety of nCLE. A structured training program and device improvements to allow more complete mapping of the pancreatic cyst epithelium will be crucial for the widespread adoption of this promising technology.

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Molecular Pathology of Pancreatic Cystic Lesions with a Focus on Malignant Progression
Yan Hu, Dan Jones, Ashwini K. Esnakula, Somashekar G. Krishna, Wei Chen
Cancers.2024; 16(6): 1183. CrossRef
Applications and Prospects of Artificial Intelligence-Assisted Endoscopic Ultrasound in Digestive System Diseases
Jia Huang, Xiaofei Fan, Wentian Liu
Diagnostics.2023; 13(17): 2815. CrossRef
EUS-guided fine needle aspiration-based clues to mistaken or uncertain identity: serous pancreatic cysts
Michele T. Yip-Schneider, Rodica Muraru, Rachel C. Kim, Howard H. Wu, Stuart Sherman, Aditya Gutta, Mohammad A. Al-Haddad, John M. Dewitt, C. Max Schmidt
HPB.2023; 25(12): 1587. CrossRef
Current trends in the management of pancreatic cystic neoplasms in Korea: a national survey
Hyung Ku Chon, Sung Hoon Moon, Sang Wook Park, Woo Hyun Paik, Chang Nyol Paik, Byoung Kwan Son, Tae Jun Song, Dong Won Ahn, Eaum Seok Lee, Yun Nah Lee, Yoon Suk Lee, Jae Min Lee, Tae Joo Jeon, Chang-Hwan Park, Kwang Bum Cho, Dong Wook Lee
The Korean Journal of Internal Medicine.2022; 37(1): 63. CrossRef
Confocal Laser Endomicroscopy in the Diagnosis of Biliary and Pancreatic Disorders: A Systematic Analysis
Do Han Kim, Somashekar G. Krishna, Emmanuel Coronel, Paul T. Kröner, Herbert C. Wolfsen, Michael B. Wallace, Juan E. Corral
Clinical Endoscopy.2022; 55(2): 197. CrossRef
Accuracy and agreement of a large panel of endosonographers for endomicroscopy-guided virtual biopsy of pancreatic cystic lesions
Jorge D. Machicado, Bertrand Napoleon, Anne Marie Lennon, Samer El-Dika, Stephen P. Pereira, Damien Tan, Rahul Pannala, Mohit Girotra, Pradermchai Kongkam, Helga Bertani, Yunlu Feng, Hao Sijie, Ning Zhong, Vincent Valantin, Sarah Leblanc, Alice Hinton, So
Pancreatology.2022; 22(7): 994. CrossRef
Pancreatic Cystic Lesions: A Focused Review on Cyst Clinicopathological Features and Advanced Diagnostics
Wei Chen, Nehaal Ahmed, Somashekar G. Krishna
Diagnostics.2022; 13(1): 65. CrossRef
Diagnostic Value of Endomicroscopy for Gastrointestinal Diseases: New Possibilities and Concepts
Ralf Kiesslich
Techniques and Innovations in Gastrointestinal Endoscopy.2021; 23(1): 57. CrossRef

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Survival Benefit of Intraductal Radiofrequency Ablation for Malignant Biliary Obstruction: A Systematic Review with Meta-Analysis: Byung Hyo Cha, Myoung-Jin Jang, Sang Hyub Lee; Clin Endosc 2021;54(1):100-106. Published online January 15, 2021; DOI: https://doi.org/10.5946/ce.2020.254

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Background
/Aims: Cholangiocarcinoma (CCA) is a rare but aggressive disease with a poor survival. Recent trials have shown improved survival with intraductal radiofrequency ablation (RFA) therapy. We performed a systematic review with meta-analysis to determine the survival benefit of endoscopic RFA for unresectable extrahepatic CCA with malignant biliary obstruction (MBO).
Methods
A systematic search from 1970 to 2020 was performed in MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials. gov. We selected eligible studies reporting relative risks, hazard ratios (HRs), or odds ratios, adjusted by controlling for confounding factors of survival rate and stent patency duration, among patients with extrahepatic CCA with MBO treated with RFA with stent insertion or stent insertion only.
Results
A total of eight trials (three randomized and five nonrandomized) with a total of 420 patients were included in the metaanalysis. Pooled overall survival analysis favored RFA treatment with stent insertion (HR, 0.47; 95% confidence interval [CI], 0.34– 0.64; I²=47%; p=0.09); however, no significant difference was found in the duration of stent patency between the groups (HR, 0.79; 95% CI, 0.57–1.09; I²=7%; p=0.36).
Conclusions
RFA therapy with stent insertion may confer a survival benefit compared with stent insertion only in patients with CCA and MBO.

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Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis
Matheus de Oliveira Veras, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Guilherme Henrique Peixoto de Oliveira, Rômulo Sérgio Araújo Gomes, Davi Lucena Landim, Felipe Giacobo Nunes, Tomazo Antônio Prince Franzini, Marcos Eduardo Lera dos Santos, W
Endoscopy International Open.2024; 12(01): E23. CrossRef
Reply to Chandrasekhara and Aggarwal
Matheus de Oliveira Veras, Diogo Turiani Hourneaux de Moura, Eduardo Guimarães Hourneaux de Moura
Endoscopy International Open.2024; 12(05): E640. CrossRef
Consensus statements on endoscopic radiofrequency ablation for malignant biliary strictures

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The Impact of Radiofrequency Ablation on Survival Outcomes and Stent Patency in Patients with Unresectable Cholangiocarcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Daniele Balducci, Michele Montori, Francesco Martini, Marco Valvano, Federico De Blasio, Maria Eva Argenziano, Giuseppe Tarantino, Antonio Benedetti, Emanuele Bendia, Marco Marzioni, Luca Maroni
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Il Sang Shin, Jong Ho Moon, Yun Nah Lee, Jun Ho Myeong, Tae Hoon Lee, Jae Kook Yang, Young Deok Cho, Sang-Heum Park
Endoscopy International Open.2024; 12(04): E535. CrossRef
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Wei Cui, Jing-Zhi Huang, Qi Wang, Feng Shi, Qing Gou, Xiao-Ming Chen, Jing Zhang, Jia-Ping Li, Rongde Xu
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Yuechuan Li, Kunshan Yuan, Chengchen Deng, Hui Tang, Jinxuan Wang, Xiaozhen Dai, Bing Zhang, Ziru Sun, Guiying Ren, Haijun Zhang, Guixue Wang
Bioactive Materials.2024; 42: 587. CrossRef
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Xu’an Wang, Yongrui Bai, Ningli Chai, Yexiong Li, Enqiang Linghu, Liwei Wang, Yingbin Liu
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Chao Zhang, Linzhong Zhu, Shousheng Tang, Jukun Wang, Yu Li, Xin Chen, Chunjing Bian, Dongbin Liu, Guokun Ao, Tao Luo
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Hayat Khizar, Yufei Hu, Yanhua Wu, Kamran Ali, Junaid Iqbal, Muhammad Zulqarnain, Jianfeng Yang
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Namyoung Park, Min Kyu Jung, Eui Joo Kim, Woo Hyun Paik, Jae Hee Cho
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Abhishek Agnihotri, David E. Loren
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Effect of Aspiration Therapy on Obesity-Related Comorbidities: Systematic Review and Meta-Analysis: Pichamol Jirapinyo, Diogo T. H. de Moura, Laura C. Horton, Christopher C. Thompson; Clin Endosc 2020;53(6):686-697. Published online February 28, 2020; DOI: https://doi.org/10.5946/ce.2019.181

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Background
/Aims: Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities.
Methods
A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs).
Results
Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 – -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 – 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 – -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7–6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 – -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 – -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 – -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p<0.0001 for all). Subgroup analysis of 2 randomized controlled trials (n=225) showed that AT patients lost more weight than did controls by 11.6 (6.5–16.7) %TWL and 25.6 (16.0–35.3) %EWL and experienced greater improvement in HbA1c and alanine transaminase by 1.3 (0.8–1.8) % and 9.0 (3.9–14.0) U/L. The pooled SAE rate was 4.1%.
Conclusions
Obesity-related comorbidities significantly improved at 1 year following AT. Additionally, a subgroup of patients who continued to use AT appeared to experience significant weight loss that persisted up to at least 4 years.

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Update on Endoscopic Treatments for Obesity
Fernanda Pessorrusso, Sagar V. Mehta, Shelby Sullivan
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Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
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Endoscopic Ultrasound-Guided, Percutaneous, and Transjugular Liver Biopsy: A Comparative Systematic Review and Meta-Analysis: Thomas R. McCarty, Ahmad Najdat Bazarbashi, Basile Njei, Marvin Ryou, Harry R. Aslanian, Thiruvengadam Muniraj; Clin Endosc 2020;53(5):583-593. Published online September 29, 2020; DOI: https://doi.org/10.5946/ce.2019.211

Abstract PDF Supplementary Material PubReader ePub

Background
/Aims: Percutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed to obtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB.
Methods
Search strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included the following: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length of longest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, and TJLB) were included.
Results
Five studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates for EUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsy needles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB and TJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) and LLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351), fewer CPT (p=0.042), and longer TSL (p=0.005).
Conclusions
EUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsy specimens obtained and rate of adverse events associated with each method.

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Methods that Assist Traction during Endoscopic Submucosal Dissection of Superficial Gastrointestinal Cancers: A Systematic Literature Review: Georgios Tziatzios, Alanna Ebigbo, Stefan Karl Gölder, Andreas Probst, Helmut Messmann; Clin Endosc 2020;53(3):286-301. Published online January 9, 2020; DOI: https://doi.org/10.5946/ce.2019.147

Abstract PDF Supplementary Material PubReader ePub

Endoscopic submucosal dissection (ESD) is a well-established method for the treatment of early-stage gastrointestinal neoplasms. Adequate submucosal exposure is one of the most significant factors related to an effective and safe dissection. The aim of this systematic review was to evaluate the effcacy and safety of various methods that assist traction during ESD of precancerous and earlystage neoplastic lesions of the gastrointestinal tract. We performed an electronic search of the MEDLINE and the Cochrane Controlled Trials Register databases for relevant studies published up to May 2019. Trials exclusively recruiting patients undergoing ESD for superficial gastrointestinal cancer were considered eligible for inclusion. Thirty-three articles including 3,134 patients met the inclusion criteria. The studies evaluated different approaches for widening the endoscopic view, including magnetic anchor-guided ESD (3 studies), use of a second endoscope (5 studies), clip-involving technique (21 studies), and miscellaneous methods (4 studies). Among them, only 6 were randomized controlled trials evaluating different approaches. Overall, the implementation of methods that assist traction during ESD significantly improved the operating time and R0 resection rate and decreased the rate of complications (bleeding and perforation). Interventions that assist traction seem effcacious in improving tissue traction, thus facilitating ESD performance.

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Current Status in the Treatment of Acute Cholecystitis Patients Receiving Antithrombotic Therapy: Is Endoscopic Drainage Feasible?- A Systematic Review: Ryota Sagami, Kenji Hayasaka, Hidefumi Nishikiori, Hideaki Harada, Yuji Amano; Clin Endosc 2020;53(2):176-188. Published online January 9, 2020; DOI: https://doi.org/10.5946/ce.2019.177

Abstract PDF PubReader ePub

The bleeding complication risk of surgery or percutaneous transhepatic gallbladder drainage (PTGBD) may increase in patients with acute cholecystitis receiving antithrombotic therapy (ATT). Endoscopic gallbladder drainage (EGBD) may be recommended for such patients. English articles published between 1991 and 2018 in peer-reviewed journals that discuss cholecystectomy, PTGBD, and EGBD in patients with ATT or coagulopathy were reviewed to assess the safety of the procedures, especially in terms of the bleeding complication. There were 8 studies on cholecystectomy, 3 on PTGBD, and 1 on endoscopic transpapillary gallbladder drainage (ETGBD) in patients receiving ATT. With respect to EGBD, 28 studies on ETGBD (including 1 study already mentioned above) and 26 studies on endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) were also analyzed. The overall bleeding complication rate in patients with ATT who underwent cholecystectomy was significantly higher than that in patients without ATT (6.5% [23/354] vs. 1.2% [26/2,224], p<0.001). However, the bleeding risk of cholecystectomy and PTGBD in patients receiving ATT was controversial. The overall technical success, clinical success, and bleeding complication rates of ETGBD vs. EUS-GBD were 84% vs. 96% (p<0.001), 92% vs. 97% (p<0.001), and 0.65% vs. 2.1% (p=0.005), respectively. One patient treated with ETGBD experienced bleeding complication among 191 patients with bleeding tendency. ETGBD may be an ideal drainage procedure for patients receiving ATT from the viewpoint of bleeding, although EUS-GBD is also efficacious.

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208 Download
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Role of Cardiac Septal Occluders in the Treatment of Gastrointestinal Fistulas: A Systematic Review: Diogo Turiani Hourneaux De Moura, Alberto Baptista, Pichamol Jirapinyo, Eduardo Guimarães Hourneaux De Moura, Christopher Thompson; Clin Endosc 2020;53(1):37-48. Published online July 9, 2019; DOI: https://doi.org/10.5946/ce.2019.030

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Treating gastrointestinal (GI) fistulas endoscopically is challenging owing to an established epithelial tract. The variety of endoscopic approaches is transforming endoscopy into a first-line therapy. However, many sessions are often required, with variable success rates. Owing to these limitations, the off-label use of cardiac septal occluders (CSOs) has been reported.
We searched for articles related to CSOs in the MEDLINE, EMBASE, Cochrane Library, and LILACS databases and gray literature. The primary outcomes included technical success, clinical success, and safety of CSOs in GI fistula management.
A total of 25,574 records were identified, and 19 studies ultimately satisfied the inclusion criteria. Technical success was achieved in all cases. Of the 22 fistulas, 77.27% had successful closure, with a mean follow-up period of 32.02 weeks. The adverse event rate was 22.72%, with no associated mortality. Univariable and multivariable regression analyses showed no significant difference in the success of closure and adverse events in relation to several variables among the subgroups.
The use of CSOs appeared to be technically feasible, effective, and safe in the treatment of GI fistulas. The satisfactory results derived from this sparse literature suggest that it can be an option in the management of GI fistulas.

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Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas: Basic principles and recommendations
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World Journal of Gastroenterology.2023; 29(7): 1173. CrossRef
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Diogo Turiani Hourneaux de Moura, Anna Carolina Batista Dantas, Igor Braga Ribeiro, Thomas R McCarty, Flávio Roberto Takeda, Marco Aurelio Santo, Sergio Carlos Nahas, Eduardo Guimarães Hourneaux de Moura
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Efficacy of Nasobiliary Tubes and Biliary Stents in Management of Patients with Bile Leak after Liver Transplantation: A Systematic Review: Ali Raza, Anam Omer, Sara Iqbal, Vineet Gudsoorkar, Pramoda Koduru, Kumar Krishnan; Clin Endosc 2019;52(2):159-167. Published online March 29, 2019; DOI: https://doi.org/10.5946/ce.2018.118

Abstract PDF PubReader ePub

Background
/Aims: Bile leak is one of the most common complications of liver transplantation. The treatment options for bile leaks include conservative management, surgical re-intervention, percutaneous drainage and endoscopic drainage. We aimed to perform a systematic review to identify the efficacy of endoscopic treatment in the resolution of post-transplant bile leaks. Methods: Two independent reviewers performed systematic literature search in PubMed, ISI Web of Science, grey literature and relevant references in May 2017. Human studies in English with documented post-liver transplant bile leaks were included. Results: Thirty-four studies were included in the final analysis. The pooled efficacy of biliary stents for the resolution of post-transplant bile leaks was 82.43% compared with 87.15% efficacy of nasobiliary tubes. The efficacy of biliary stents was lower for anastomotic leaks (69.23%) compared to T-tube (90.9%) or cut-surface/ cystic duct stump related leaks (92.8%). Similarly, the efficacy of nasobiliary tube was also lower for anastomotic leaks (58.33%) compared to T-tube or cut-surface related leaks (100%). Conclusions: In this systematic review, the overall efficacy was 82.43% in biliary stent group, and 87.15% in nasobiliary tube group. Both biliary stent and nasobiliary tube were more effective in managing non-anastomotic leaks compared to anastomotic leaks.

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Transplantation Direct.2021; 7(10): e754. CrossRef
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Clinical Endoscopy.2020; 53(6): 633. CrossRef

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Endoscopic Ultrasound-Guided Gallbladder Drainage Using a Lumen-Apposing Metal Stent for Acute Cholecystitis: A Systematic Review: Deepanshu Jain, Bharat Singh Bhandari, Nikhil Agrawal, Shashideep Singhal; Clin Endosc 2018;51(5):450-462. Published online June 1, 2018; DOI: https://doi.org/10.5946/ce.2018.024

Abstract PDF PubReader ePub

Surgery remains the standard treatment for acute cholecystitis except in high-risk candidates where percutaneous transhepatic gallbladder drainage (PT-GBD), endoscopic transpapillary cystic duct stenting (ET-CDS), and endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) are potential choices. PT-GBD is contraindicated in patients with coagulopathy or ascites and is not preferred by patients owing to aesthetic reasons. ET-CDS is successful only if the cystic duct can be visualized and cannulated. For 189 patients who underwent EUS-GBD via insertion of a lumen-apposing metal stent (LAMS), the composite technical success rate was 95.2%, which increased to 96.8% when LAMS was combined with co-axial self-expandable metal stent (SEMS). The composite clinical success rate was 96.7%. We observed a small risk of recurrent cholecystitis (5.1%), gastrointestinal bleeding (2.6%) and stent migration (1.1%). Cautery enhanced LAMS significantly decreases the stent deployment time compared to non-cautery enhanced LAMS. Prophylactic placement of a pigtail stent or SEMS through the LAMS avoids re-interventions, particularly in patients, where it is intended to remain in situ indefinitely. Limited evidence suggests that the efficacy of EUS-GBD via LAMS is comparable to that of PT-GBD with the former showing better results in postoperative pain, length of hospitalization, and need for antibiotics. EUS-GBD via LAMS is a safe and efficacious option when performed by experts.

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Carbon Dioxide versus Air Insufflation in Gastric Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Ramkaji Baniya, Sunil Upadhaya, Jahangir Khan, Suresh K Subedi, Tabrez S Mohammed, Balvant K Ganatra, Ghassan Bachuwa; Clin Endosc 2017;50(5):464-472. Published online May 18, 2017; DOI: https://doi.org/10.5946/ce.2016.161

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Background
/Aims: Endoscopic submucosal dissection (ESD) with air insufflation is commonly used for the staging and treatment of early gastric carcinoma. However, carbon dioxide (CO₂) use has been shown to cause less post-procedural pain and fewer adverse events. The objective of this study was to compare the post-procedural pain and adverse events associated with CO₂ and air insufflation in ESD.
Methods
A systematic search was conducted for randomized control trials (RCTs) comparing the two approaches in ESD. The Mantel-Haenszel method was used to analyze the data. The mean difference (MD) and odds ratio (OR) were used for continuous and categorical variables, respectively.
Results
Four RCTs with a total of 391 patients who underwent ESD were included in our meta-analysis. The difference in maximal post-procedural pain between the two groups was statistically significant (MD, -7.41; 95% confidence interval [CI], -13.6 – -1.21; p=0.020). However, no significant differences were found in the length of procedure, end-tidal CO₂, rate of perforation, and postprocedural hemorrhage between the two groups. The incidence of overall adverse events was significantly lower in the CO₂ group (OR, 0.51; CI, 0.32–0.84; p=0.007).
Conclusions
CO₂ insufflation in gastric ESD is associated with less post-operative pain and discomfort, and a lower risk of overall adverse events compared with air insufflation.

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Systematic review, meta-analysis