Clinical Endoscopy

Review

Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control: Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura; Clin Endosc 2024;57(3):309-316. Published online February 15, 2024; DOI: https://doi.org/10.5946/ce.2023.217

The treatment of obesity and its comorbidities ranges from clinical management involving lifestyle changes and medications to bariatric and metabolic surgery. Various endoscopic bariatric and metabolic therapies recently emerged to address an important therapeutic gap by offering a less invasive alternative to surgery that is more effective than conservative therapies. This article comprehensively reviews the technical aspects, mechanism of action, outcomes, and future perspectives of one of the most promising endoscopic bariatric and metabolic therapies, named duodenojejunal bypass liner. The duodenojejunal bypass liner mimics the mechanism of Roux-en-Y gastric bypass by preventing food contact with the duodenum and proximal jejunum, thereby initiating a series of hormonal changes that lead to delayed gastric emptying and malabsorptive effects. These physiological changes result in significant weight loss and improved metabolic control, leading to better glycemic levels, preventing dyslipidemia and non-alcoholic fatty liver disease, and mitigating cardiovascular risk. However, concern exists regarding the safety profile of this device due to the reported high rates of severe adverse events, particularly liver abscesses. Ongoing technical changes aiming to reduce adverse events are being evaluated in clinical trials and may provide more reliable data to support its routine use in clinical practice.

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Bacteroides and NAFLD: pathophysiology and therapy
Jun Zhang, Jing Zhou, Zheyun He, Hongshan Li
Frontiers in Microbiology.2024;[Epub] CrossRef

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Systematic Review and Meta-analysis

Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett’s esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis: Igor Logetto Caetité Gomes, Diogo Turiani Hourneaux de Moura, Igor Braga Ribeiro, Sérgio Barbosa Marques, Alexandre de Sousa Carlos, Beanie Conceição Medeiros Nunes, Bruno Salomão Hirsch, Guilherme Henrique Peixoto de Oliveira, Roberto Paolo Trasolini, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2024;57(2):181-190. Published online January 17, 2024; DOI: https://doi.org/10.5946/ce.2023.065

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Background
/Aims: Radiofrequency ablation (RFA) is the first-line therapy for dysplastic Barrett’s esophagus (BE). Therefore, cryotherapy has emerged as an alternative treatment option. This study aimed to compare the efficacies of these two techniques based on the rates of complete eradication of intestinal metaplasia (CE-IM) and dysplasia (CE-D). Adverse events and recurrence have also been reported.
Methods
An electronic search was conducted using the Medline (PubMed), Embase, LILACS, and Google Scholar databases until December 2022. Studies were included comparing cryotherapy and RFA for treating dysplastic BE with or without early esophageal neoplasia. This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results
Three retrospective cohort studies involving 627 patients were included. Of these, 399 patients underwent RFA, and 228 were treated with cryotherapy. There was no difference in CE-IM (risk difference [RD], –0.03; 95% confidence interval [CI], –0.25 to 0.19; p=0.78; I2=86%) as well as in CE-D (RD, –0.03; 95% CI, –0.15 to 0.09; p=0.64; I2=70%) between the groups. The absolute number of adverse events was low, and there was no difference in the recurrence rate.
Conclusions
Cryotherapy and RFA were equally effective in treating dysplastic BE, with or without early esophageal neoplasia.

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Efficacy and Safety of Cryoablation in Barrett’s Esophagus and Comparison with Radiofrequency Ablation: A Meta-Analysis
Apostolis Papaefthymiou, Benjamin Norton, Andrea Telese, Daryl Ramai, Alberto Murino, Paraskevas Gkolfakis, John Vargo, Rehan J. Haidry
Cancers.2024; 16(17): 2937. CrossRef

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Editorial

Understanding hybrid endoscopic submucosal dissection subtleties: João Paulo de Souza Pontual, Alexandre Moraes Bestetti, Diogo Turiani Hourneaux de Moura; Clin Endosc 2023;56(6):738-740. Published online November 1, 2023; DOI: https://doi.org/10.5946/ce.2023.195

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Systematic Review and Meta-Analysises

Stent versus Balloon Dilation for the Treatment of Dominant Strictures in Primary Sclerosing Cholangitis: A Systematic Review and Meta-Analysis: Marina Tucci Gammaro Baldavira Ferreira, Igor Braga Ribeiro, Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Alberto Machado da Ponte Neto, Galileu Ferreira Ayala Farias, Antônio Afonso de Miranda Neto, Pedro Victor Aniz Gomes de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(6):833-842. Published online July 1, 2021; DOI: https://doi.org/10.5946/ce.2021.052

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Background
/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remains challenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment of dominant strictures among PSC patients.
Methods
Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studies published until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate, transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death).
Results
A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (risk difference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I²=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01; I²=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I²=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia were significantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I²=51%).
Conclusions
Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complication rates without significant differences in efficacy.

Citations

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Treatment of Non-Anastomotic Biliary Strictures after Liver Transplantation: How Effective Is Our Current Treatment Strategy?
Florian A. Michael, Mireen Friedrich-Rust, Hans-Peter Erasmus, Christiana Graf, Olivier Ballo, Mate Knabe, Dirk Walter, Christoph D. Steup, Marcus M. Mücke, Victoria T. Mücke, Kai H. Peiffer, Esra Görgülü, Antonia Mondorf, Wolf O. Bechstein, Natalie Filma
Journal of Clinical Medicine.2023; 12(10): 3491. CrossRef
Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease
You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
Intestinal Research.2023; 21(4): 420. CrossRef
Liver Transplantation for Primary Sclerosing Cholangitis (PSC) With or Without Inflammatory Bowel Disease (IBD)—A European Society of Organ Transplantation (ESOT) Consensus Statement
M. Carbone, A. Della Penna, C. Mazzarelli, E. De Martin, C. Villard, A. Bergquist, P. D. Line, J. M. Neuberger, S. Al-Shakhshir, P. J. Trivedi, U. Baumann, L. Cristoferi, J. Hov, B. Fischler, N. H. Hadzic, D. Debray, L. D’Antiga, N. Selzner, L. S. Belli,
Transplant International.2023;[Epub] CrossRef
Primary Biliary Cholangitis and Primary Sclerosing Cholangitis: Current Knowledge of Pathogenesis and Therapeutics
Ji-Won Park, Jung-Hee Kim, Sung-Eun Kim, Jang Han Jung, Myoung-Kuk Jang, Sang-Hoon Park, Myung-Seok Lee, Hyoung-Su Kim, Ki Tae Suk, Dong Joon Kim
Biomedicines.2022; 10(6): 1288. CrossRef
Use a biodegradable stent in ERCP and it will never be forgotten
Jesús García-Cano, Eva de la Santa Belda, Francisco Domper
Revista Española de Enfermedades Digestivas.2022;[Epub] CrossRef
Endoscopic stenting of dominant strictures in patients with primary sclerosing cholangitis: When, how, and for how long?
Il Sang Shin, Jong Ho Moon
Endoscopy International Open.2022; 10(09): E1169. CrossRef

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Endoscopic Band Ligation Versus Argon Plasma Coagulation in the Treatment of Gastric Antral Vascular Ectasia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Bruno Salomão Hirsch, Igor Braga Ribeiro, Mateus Pereira Funari, Diogo Turiani Hourneaux de Moura, Sergio Eiji Matuguma, Sergio A. Sánchez-Luna, Fabio Catache Mancini, Guilherme Henrique Peixoto de Oliveira, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura; Clin Endosc 2021;54(5):669-677. Published online May 31, 2021; DOI: https://doi.org/10.5946/ce.2021.063

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Background
/Aims: Argon plasma coagulation (APC) is the most commonly used endoscopic treatment for gastric antral vascular ectasia (GAVE). Endoscopic band ligation (EBL) has emerged as an alternative therapy. Our goal was to evaluate the feasibility, efficacy, and safety of APC and EBL for the treatment of GAVE. This is the first systematic review that included only randomized controlled trials (RCTs) on this topic.
Methods
A comprehensive search was performed using electronic databases to identify RCTs comparing APC and EBL for the treatment of GAVE following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.
Results
Four RCTs were included, with a total of 204 patients. EBL was related to higher endoscopic eradication rates risk difference [RD], 0.29; 95% confidence interval [CI] [0.14, 0.44]; I²=0%) and less bleeding recurrence than APC (RD, 0.29; 95% CI [0.15, 0.44]; I²=0%). Patients treated with EBL required fewer blood transfusions (mean difference [MD], 1.49; 95% CI [0.28, 2.71]; I²=96%) and hospitalizations (MD, 0.29; 95% CI [0.19, 0.39]; I²=0%). The number of sessions required for the obliteration of lesions was higher with APC. There was no difference in the incidence of adverse events.
Conclusions
EBL is superior to APC in the treatment of GAVE in terms of endoscopic eradication rates, recurrence of bleeding, and transfusion requirements.

Citations

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Role of Endoscopy in the Diagnosis, Grading, and Treatment of Portal Hypertensive Gastropathy and Gastric Antral Vascular Ectasia
Ali Khalifa, Don C. Rockey
Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 263. CrossRef
Review article: Upper gastrointestinal bleeding – review of current evidence and implications for management
Dennis L. Shung, Loren Laine
Alimentary Pharmacology & Therapeutics.2024; 59(9): 1062. CrossRef
Bevacizumab in combination with octreotide rescues a patient with liver cirrhosis, GAVE syndrome and refractory hemorrhage – a case report
Simon Johannes Gairing, Eva Maria Schleicher, Lukas Müller, Christian Labenz, Felix Darstein, Daniel Grimm, Visvakanth Sivanathan, Arndt Weinmann, Marcus-Alexander Wörns, Roman Kloeckner, Michael B. Pitton, Florian Thieringer, Khan Fareed Rahman, Peter Ro
Zeitschrift für Gastroenterologie.2023; 61(03): 275. CrossRef
A Practical Approach to the Management of Gastric Antral Vascular Ectasia
Matthew H. Meyers, Laura Rodriguez, Michael S. Kriss
American Journal of Gastroenterology.2023;[Epub] CrossRef
Endoscopic Advances in Hepatology
Emma Vanderschueren, Jonel Trebicka, Wim Laleman
Seminars in Liver Disease.2023; 43(02): 176. CrossRef
Comparisons Between Endoscopic Band Ligation, Radiofrequency Ablation and Endoscopic Thermal Therapy for Gastric Antral Vascular Ectasia: A Meta-Analysis
Cheng-Che Che, Sz-Iuan Shiu, Chung-Wang Ko, Yu-Kang Tu, Chung-Hsin Chang
Digestive Diseases and Sciences.2023; 68(9): 3534. CrossRef
An update on the management of non-variceal upper gastrointestinal bleeding
Ali A Alali, Alan N Barkun
Gastroenterology Report.2022;[Epub] CrossRef
Endoscopic band ligation in the treatment of gastric antral vascular ectasia: a systematic review and meta-analysis
Babu P. Mohan, Gregory Toy, Lena L. Kassab, Suresh Ponnada, Saurabh Chandan, Sheeva Parbhu, Shaun Chandna, Douglas G. Adler
Gastrointestinal Endoscopy.2021; 94(6): 1021. CrossRef

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Original Article

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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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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FOCUSED REVIEW SERIES: Endoscopic Managements for Patients with Obesity and Its Related Comorbidities

Various Novel and Emerging Technologies in Endoscopic Bariatric and Metabolic Treatments: Hee Kyong Na, Diogo Turiani Hourneaux De Moura, The Study Group for Endoscopic Bariatric and Metabolic Therapies of the Korean Society of Gastrointestinal Endoscopy; Clin Endosc 2021;54(1):25-31. Published online January 29, 2021; DOI: https://doi.org/10.5946/ce.2021.021

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Obesity, along with its comorbidities, has become a significant public health concern worldwide. Bariatric surgery is considered the most effective treatment modality; however, only 2% of patients with obesity undergo bariatric surgery. Endoscopic bariatric and metabolic therapies (EBMTs) are emerging alternatives to traditional bariatric surgery for patients who are not eligible for or do not prefer surgical treatment. EBMTs are generally categorized as space-occupying, gastric restrictive, aspiration, and small bowel therapies. We aimed to review various non-balloon and non-gastroplasty devices with available clinical data and discuss the possible mechanisms of action, efficacy, and safety profile of these EMBTs.

Citations

Citations to this article as recorded by

Role of endoscopic duodenojejunal bypass liner in obesity management and glycemic control
Willian Ferreira Igi, Victor Lira de Oliveira, Ayah Matar, Diogo Turiani Hourneaux de Moura
Clinical Endoscopy.2024; 57(3): 309. CrossRef
Intragastric Balloons
D.T.H. de Moura, Sergio A. Sánchez-Luna, Adriana Fernandes Silva, Alexandre Moraes Bestetti
Gastrointestinal Endoscopy Clinics of North America.2024;[Epub] CrossRef
Current State of Endoscopic Bariatric Therapies
Lee Ying, Samuel Butensky, Ysabel Ilang-Ying, Saber Ghiassi
Surgical Clinics of North America.2024;[Epub] CrossRef
Effectiveness and Safety of the Allurion Swallowable Intragastric Balloon for Short-term Weight Loss: A Systematic Review and Meta-analysis
Adriana Fernandes Silva, Alexandre Moraes Bestetti, Angelo So Taa Kum, Beanie Conceição Medeiros Nunes, Matheus de Oliveira Veras, Wanderley Marques Bernardo, Eduardo Guimarães Hourneaux de Moura
Obesity Surgery.2024;[Epub] CrossRef
The Effectiveness and Safety of the Duodenal-Jejunal Bypass Liner (DJBL) for the Management of Obesity and Glycaemic Control: a Systematic Review and Meta-Analysis of Randomized Controlled Trials
Erika Yuki Yvamoto, Diogo Turiani Hourneaux de Moura, Igor Mendonça Proença, Epifanio Silvino do Monte Junior, Igor Braga Ribeiro, Pedro Henrique Boraschi Vieira Ribas, Matheus Cândido Hemerly, Victor Lira de Oliveira, Sergio A. Sánchez-Luna, Wanderley Ma
Obesity Surgery.2023; 33(2): 585. CrossRef
A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going
Aurelio Mauro, Francesca Lusetti, Davide Scalvini, Marco Bardone, Federico De Grazia, Stefano Mazza, Lodovica Pozzi, Valentina Ravetta, Laura Rovedatti, Carmelo Sgarlata, Elena Strada, Francesca Torello Viera, Letizia Veronese, Daniel Enrique Olivo Romero
Medicina.2023; 59(3): 636. CrossRef
Endoscopic Bariatric Therapy for Obesity and Metabolic Syndrome
Sang Pyo Lee
The Korean Journal of Helicobacter and Upper Gastrointestinal Research.2023; 23(4): 247. CrossRef
The Effect of Endoscopic Bariatric and Metabolic Therapies on Gastroesophageal Reflux Disease
Su-Young Kim
Medicina.2021; 57(8): 737. CrossRef

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Original Article

Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis: Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Pichamol Jirapinyo, Igor Braga Ribeiro, Galileu Ferreira Ayala Farias, Marvin Ryou, Linda S. Lee, Christopher C. Thompson; Clin Endosc 2020;53(5):600-610. Published online December 3, 2019; DOI: https://doi.org/10.5946/ce.2019.170

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Background
/Aims: Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling.
Methods
This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events.
Results
A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported in either cohort.
Conclusions
Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUSFNA+ ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses.

Citations

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Current perspectives on the diversification of endoscopic ultrasound-guided fine-needle aspiration and biopsy
Shinpei Doi, Takako Adachi, Ayako Watanabe, Nobuhiro Katsukura, Takayuki Tsujikawa
Journal of Medical Ultrasonics.2024; 51(2): 235. CrossRef
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Mitsuru Okuno, Keisuke Iwata, Tsuyoshi Mukai, Yusuke Kito, Takuji Tanaka, Naoki Watanabe, Senji Kasahara, Yuhei Iwasa, Akihiko Sugiyama, Youichi Nishigaki, Yuhei Shibata, Junichi Kitagawa, Takuji Iwashita, Eiichi Tomita, Masahito Shimizu
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Taha Yaseen, Abbas Ali Tasneem, Syed Mudassir Laeeq, Zain Majid, Nasir Hassan Luck
Euroasian journal of hepato-gastroenterology.2024; 14(1): 40. CrossRef
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Kajornvit Raghareutai, Worapoth Yingyongthawat, Nonthalee Pausawasdi
Clinical Endoscopy.2024; 57(4): 473. CrossRef
Lymphadenopathy Tissue Sampling by EUS-Guided Fine-Needle Biopsy Contributes to Meeting the Conditions for Genomic Profiling
Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
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Hafiz Irfan Mushtaq, Fariha Shams, Shafqat Rasool, Ghias Ul Hassan, Sadia Jabbar, Farwa Javed, Sidra Rasheed, Akif Dlishad, Ghias Un Nabi Tayyab
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Flaminia Bellisario, Fabia Attili, Fabrizia Campana, Federica Borrelli de Andreis, Silvia Bellesi, Elena Maiolo, Eleonora Alma, Rosalia Malafronte, Giuseppe Macis, Luigi Maria Larocca, Salvatore Annunziata, Francesco D’Alò, Stefan Hohaus
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Adam Haig, Andrew St John, Kasturi Vaska, Xuan Banh, Alexander Huelsen
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Primary Pancreatic Lymphoma Evaluated by Fine-Needle Aspiration
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Linbin Chen, Yin Li, Xiaoyan Gao, Shiyong Lin, Longjun He, Guangyu Luo, Jianjun Li, Chunyu Huang, Guobao Wang, Qing Yang, Hongbo Shan
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Epifânio Silvino do Monte Junior, Dalton Marques Chaves, Christiano Makoto Sakai, Gustavo de Oliveira Luz, Igor Braga Ribeiro, Vitor Massaro Takamatsu Sagae, Eduardo Guimarães Hourneaux de Moura
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Irving Levine, Arvind J Trindade
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Lawrence Ku, Mohammad A Shahshahan, Linda A Hou, Viktor E Eysselein, Sofiya Reicher
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Review

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

Abstract PDF PubReader ePub

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.

Citations

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