Gastric per-oral endoscopic myotomy (G-POEM) for refractory gastroparesis: results from an international prospective trial

OBJECTIVE: Although gastric per-oral endoscopic myotomy (G-POEM) is considered a promising technique for the management of refractory gastroparesis, high-quality evidence is limited. We prospectively investigated the efficacy and safety of G-POEM in unselected patients with refractory gastroparesis. DESIGN: In five tertiary centres, patients with symptomatic gastroparesis refractory to standard medical therapy and confirmed by impaired gastric emptying were included. The primary endpoint was clinical success, defined as at least one score decrease in Gastroparesis Cardinal Symptom Index (GCSI) with ≥25% decrease in two subscales, at 12 months. GCSI Score and subscales, adverse events (AEs) and 36-Item Short Form questionnaire of quality of life were evaluated at baseline and 1, 3, 6 and 12 months after G-POEM. Gastric emptying study was performed before and 3 months after the procedure. RESULTS: Of 80 enrolled patients, 75 patients (94%) completed 12-month follow-up. Clinical success at 12 months was 56% (95% CI, 44.8 to 66.7). GCSI Score (including subscales) improved moderately after G-POEM (p\u3c0.05). In a regression model, a baseline GCSI Score \u3e2.6 (OR=3.23, p=0.04) and baseline gastric retention \u3e20% at 4 hours (OR=3.65, p=0.03) were independent predictors of clinical success at 12 months, as was early response to G-POEM at 1 month after therapy (OR 8.75, p\u3c0.001). Mild procedure-related AEs occurred in 5 (6%) patients. CONCLUSION: G-POEM is a safe procedure, but showed only modest overall effectiveness in the treatment of refractory gastroparesis. Further studies are required to identify the best candidates for G-POEM; unselective use of this procedure should be discouraged. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry NCT02732821

Colangiografía por resonancia magnética y ultrasonido endoscópico en el diagnóstico de pacientes con ictericia obstructiva por litiasis biliar y pancreatitis aguda biliar

Introducción y objetivo: La litiasis es la principal causa de obstrucción, dilatación de la vía biliar y pancreatitis aguda en nuestro medio; existen criterios clínicos de laboratorio e imagenológico para establecer nivel de obstrucción y la causa. Se realizó un estudio comparando la utilidad diagnóstica de 2 pruebas (ecoendoscopia y colangioresonancia) en las patologías biliopancreáticas litiasis. Método: Estudio observacional, comparativo y retrospectivo; incluyó 14 pacientes (5 hombres y 9 mujeres) a quienes se le practicaron ambas modalidades diagnósticas teniendo como prueba de oro la cirugía, colangiografía retrógrada endoscópica y seguimiento. Resultados: La edad media fue de 54 años. Los diagnósticos fueron litiasis biliar obstructiva (78,57 %) y pancreatitis aguda biliar (21,43 %). Como prueba diagnóstica, ultrasonido endoscópico tuvo sensibilidad, especificidad, valores predictivos positivo y negativo del 100 %, en cada caso, razones de probabilidad positiva y negativa 1,01 y 0,99, respectivamente. Colangioresonancia tuvo sensibilidad 45 %, especificidad 66,6 %,valor predictivo positivo 83,3 %, valor predictivo negativo 25 %, razones de probabilidad positiva y negativa 1,36 y 0,82 respectivamente. Conclusiones: El presente estudio confirmó al USE como un procedimiento preciso y adecuado para realizar el diagnóstico de cálculos biliare

Validation of teixeira optic magnifying fice vascular pattern of colorectal lesions with optic magnifying nbi: a pilot study

Objective: A recent classification of the vascular pattern (VP) of colorectal polyps was introduced by Teixeira et al, using magnifying FICE. This pilot study aims to achieve Teixeira’s FICE VP classification (TVP) of colorectal lesions through NBI magnification. Methods: From 2010 to 2011, 32 patients and 54 colorectal lesions were evaluated at Centro Médico Docente La Trinidad (CMDLT), Department of Gastroenterology, Caracas-Venezuela.  Olympus magnifying colonoscopies and NBI were performed by three independent endoscopists, using the TVP classification. A fourth endoscopist of Porto Alegre-Brazil from the Department of Gastroenterology of FUGAST received the electronic files of the 54 cases in a digital image filing system. Random numbers of 54 pictures were allocated to readers 1 to 4. Diagnostic accuracy of the TVP was determined against the histopathological diagnosis, as neoplasia or no neoplasia; adenoma with low/high grade dysplasia vs. deeply invasive adenocarcinoma. Kappa in reference to TVP was recorded. Specificity, sensibility, positive (PPV) and negative (PPN) predictive values to assess the neoplastic or non neoplastic nature of the lesion were determined. Results: Kappa values of 0.84259259 (0.63-0.84); Specificity (0.943 ± 0.013); sensibility (0.825 ± 0.126); PPV (0.960 ± 0.029) and PPN (0.765 ± 0.062) were obtained for TVP. Conclusions: This pilot study shows that a formerly TVP, can be reproduced with Olympus magnifying NBI. Since no VP classification has yet proven to be paramount in predicting the histology in colorectal lesions, a larger scale trial using both systems would be the best way to attain a more universal classification