Comparative performance and external validation of three different scores in predicting inadequate bowel preparation among Greek inpatients undergoing colonoscopy

Background Predictive scores aim to predict bowel preparation adequacy among hospitalized patients undergoing colonoscopy. We evaluated the comparative efficacy of these scores in predicting inadequate bowel cleansing in a cohort of Greek inpatients. Methods We performed a post hoc analysis of data generated from a cohort of inpatients undergoing colonoscopy in 4 tertiary Greek centers to validate the 3 models currently available (models A, B and C). We used the Akaike information criterion to quantify the performance of each model, while Harrell's C-index, as the area under the receiver operating characteristics curve (AUC), verified the discriminative ability to predict inadequate bowel prep. Primary endpoint was the comparison of performance among models for predicting inadequate bowel cleansing. 70.7 +/- 15.4 years-were included in the analysis. Model B showed the highest performance (Harrell's C-index: AUC 77.2% vs. 72.6% and 57.5%, compared to models A and C, respectively). It also achieved higher performance for the subgroup of mobilized inpatients (Harrell's C-index: AUC 72.21% vs. 64.97% and 59.66%, compared to models A and C, respectively). Model B also performed better in predicting patients with incomplete colonoscopy due to inadequate bowel preparation (Harrell's C-index: AUC 74.23% vs. 69.07% and 52.76%, compared to models A and C, respectively).Conclusions Predictive model B outperforms its comparators in the prediction of inpatients with inadequate bowel preparation. This model is particularly advantageous when used to evaluate mobilized inpatients

Performance and Safety of EUS Ablation Techniques for Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis

Background: Pancreatic cystic lesions (PCL) represent an increasingly diagnosed condition with significant burden to patients’ lives and medical resources. Endoscopic ultrasound (EUS) ablation techniques have been utilized to treat focal pancreatic lesions. This systematic review with meta-analysis aims to assess the efficacy of EUS ablation on PCL in terms of complete or partial response and safety. Methods: A systematic search in Medline, Cochrane and Scopus databases was performed in April 2023 for studies assessing the performance of the various EUS ablation techniques. The primary outcome was complete cyst resolution, defined as cyst disappearance in follow-up imaging. Secondary outcomes included partial resolution (reduction in PCL size), and adverse events rate. A subgroup analysis was planned to evaluate the impact of the available ablation techniques (ethanol, ethanol/paclitaxel, radiofrequency ablation (RFA), and lauromacrogol) on the results. Meta-analyses using a random effects model were conducted and the results were reported as percentages with 95% confidence intervals (95%CI). Results: Fifteen studies (840 patients) were eligible for analysis. Complete cyst resolution after EUS ablation was achieved in 44% of cases (95%CI: 31–57; 352/767; I2 = 93.7%), and the respective partial response rate was 30% (95%CI: 20–39; 206/767; I2 = 86.1%). Adverse events were recorded in 14% (95%CI: 8–20; 164/840; I2 = 87.2%) of cases, rated as mild in 10% (95%CI: 5–15; 128/840; I2 = 86.7%), and severe in 4% (95%CI: 3–5; 36/840; I2 = 0%). The subgroup analysis for the primary outcome revealed rates of 70% (95%CI: 64–76; I2 = 42.3%) for ethanol/paclitaxel, 44% (95%CI: 33–54; I2= 0%) for lauromacrogol, 32% (95%CI: 27–36; I2 = 88.4%) for ethanol, and 13% (95%CI: 4–22; I2 = 95.8%) for RFA. Considering adverse events, the ethanol-based subgroup rated the highest percentage (16%; 95%CI: 13–20; I2 = 91.0%). Conclusion: EUS ablation of pancreatic cysts provides acceptable rates of complete resolution and a low incidence of severe adverse events, with chemoablative agents yielding higher performance rates

The role of small intestinal bacterial overgrowth syndrome in patients with non alcoholic fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is a multifactorial, wide spectrum liver disorder. Small intestinal bacterial overgrowth (SIBO) is characterized by an increase in the number and/or type of colonic bacteria in the upper gastrointestinal tract. SIBO, through energy salvage and induction of inflammation, may be a pathophysiological factor for NAFLD development and progression. Aim/Methods: Patients with histological, biochemical, or radiological diagnosis of any stage of NAFLD (non-alcoholic fatty liver [NAFL], non-alcoholic steatohepatitis [NASH], cirrhosis) underwent upper gastrointestinal endoscopy. Duodenal fluid (2cc) was aspirated from the 3rd–4th part of duodenum into sterile containers. SIBO was defined as ≥ 103 aerobic colony-forming units (CFU)/mL of duodenal aspirate and/or the presence of colonic-type bacteria. Patients without any liver disease undergoing gastroscopy due to gastroesophageal reflux disease (GERD) comprised the healthy control (HC) group. The primary endpoint was to evaluate the prevalence of SIBO in NAFLD patients, while the comparison of SIBO prevalence among NAFLD patients and healthy controls was a secondary endpoint. Results: We enrolled 125 patients (51 NAFL, 27 NASH, 17 cirrhosis, and 30 HC) aged 54 ± 11.9 years. Overall, SIBO was diagnosed in 23/125 (18.4%) patients, with Gram-negative bacteria being the predominant species (19/23; 82.6%). SIBO prevalence was higher in the NAFLD cohort compared to HC (22/95; 23.2% vs. 1/30; 3.3%, p = 0.014). Patients with NASH had higher SIBO prevalence (6/27; 22.2%) compared to NAFL individuals (8/51; 15.7%), but this difference did not reach statistical significance (p = 0.11). Patients with NASH-associated cirrhosis had a higher SIBO prevalence compared to patients with NAFL (8/17; 47.1% vs. 8/51; 15.7%, p = 0.02), while SIBO prevalence between patients with NASH-associated cirrhosis and NASH was not statistically different (8/17; 47.1% vs. 6/27; 22.2%, p = 0.11). Conclusion: The prevalence of SIBO is significantly higher in a cohort of patients with NAFLD compared to healthy controls. Moreover, SIBO is more prevalent in patients with NASH-associated cirrhosis compared to patients with NAFL.Εισαγωγή: Η Μη-Αλκοολική Λιπώδης Νόσος του Ήπατος (ΜΑΛΝΗ) είναι μια πολυπαραγοντική διαταραχή με ευρύ φάσμα κλινικών εκδηλώσεων. Το σύνδρομο βακτηριακής υπερανάπτυξης του λεπτού εντέρου (ΣΒΥΛΕ) χαρακτηρίζεται από αυξημένο αριθμό ή παρουσία βακτηρίων τύπου παχέος εντέρου στο λεπτό έντερο. Το ΣΒΥΛΕ μέσω της δημιουργίας περίσσειας ενεργειακών αποθεμάτων και πρόκλησης φλεγμονής θα μπορούσε να αποτελέσει έναν παθοφυσιολογικό μηχανισμό για την ανάπτυξη ΜΑΛΝΗ. Σκοπός – Μέθοδος: Ασθενείς με ιστολογική, βιοχημική ή ακτινολογική διάγνωση ΜΑΛΝΗ [Μη-Αλκοολικό Λιπώδες Ήπαρ (ΜΑΛΗ), Μη-Αλκοολική Στεατοηπατίτιδα (ΜΑΣΗ), κίρρωση] υπεβλήθησαν σε γαστροσκόπηση και δωδεκαδακτυλικό υγρό αναρροφήθηκε σε αποστειρωμένες παγίδες. Το ΣΒΥΛΕ ορίστηκε ως ≥103 CFU / ml αναρρόφησης δωδεκαδακτύλου και / ή παρουσία βακτηρίων παχέος εντέρου. Ασθενείς ελεύθεροι ηπατικής νόσου που υπεβλήθησαν σε γαστροσκόπηση λόγω συμπτωμάτων γαστροοισοφαγικής παλινδρόμησης αποτέλεσαν την ομάδα ελέγχου (ΟΕ). Το πρωτογενές καταληκτικό σημείο ήταν ο επιπολασμός του ΣΒΥΛΕ σε ασθενείς με ΜΑΛΝΗ, ενώ η σύγκριση του επιπολασμού του συνδρόμου στα διάφορα στάδια της νόσου αποτέλεσε ένα από τα δευτερογενή καταληκτικά σημεία της μελέτης. Αποτελέσματα: Συμπεριελήφθησαν 125 ασθενείς (51 ΜΑΛΗ, 27 ΜΑΣΗ, 17 κίρρωση και 30 ΟΕ). Η μέση ηλικία ήταν 54 ± 11,9 έτη. ΣΒΥΛΕ διαγνώστηκε σε 23/125 (18.4%) ασθενείς με υπεροχή των Gram,-αρνητικών βακτηρίων (19/23, 82,6%). Ο επιπολασμός του συνδρόμου ήταν μεγαλύτερος στους ασθενείς με ΜΑΛΝΗ σε σύγκριση με την ΟΕ (22/95, 23,2% έναντι 1/30, 3,3%, p = 0,014). Οι ασθενείς με ΜΑΣΗ έπασχαν πιο συχνά από ΣΒΥΛΕ σε σύγκριση με τους ασθενείς με ΜΑΛΗ (6/27, 22,2% έναντι 8/51, 15,7%) αλλά χωρίς στατιστικά σημαντική διαφορά (p = 0,11). Ο επιπολασμός του ΣΒΥΛΕ ήταν μεγαλύτερος στους ασθενείς με ΜΑΣΗ- κίρρωση σε σύγκριση με τους ασθενείς με ΜΑΛΗ (8/17, 47,1% έναντι 8/51, 15,7%, p = 0,02), ενώ ο επιπολασμός δε διέφερε ανάμεσα σε ασθενείς με κίρρωση και ΜΑΣΗ (8/17, 47,1% έναντι 6/27, 22,2%, p = 0,11).118. Συμπέρασμα: Ο επιπολασμός του ΣΒΥΛΕ είναι σημαντικά υψηλότερος σε ασθενείς με ΜΑΛΝΗ σε σύγκριση με την ομάδα ελέγχου. Επιπρόσθετα, το ΣΒΥΛΕ είναι πιο συχνό σε ασθενείς με ΜΑΣΗ-σχετιζόμενη κίρρωση σε σύγκριση με ασθενείς με ΜΑΛΗ

Recent Developments in the Field of Endoscopic Ultrasound for Diagnosis, Staging, and Treatment of Pancreatic Lesions

Endoscopic ultrasound (EUS) plays a crucial role in the diagnosis of both solid and cystic pancreatic lesions and in the staging of patients with pancreatic cancer through its use for tissue and fluid sampling. Additionally, in cases of precancerous lesions, EUS-guided therapy can also be provided. This review aims to describe the most recent developments regarding the role of EUS in the diagnosis and staging of pancreatic lesions. Moreover, complementary EUS imaging modalities, the role of artificial intelligence, new devices, and modalities for tissue acquisition, and techniques for EUS-guided treatment are discussed

Recent Developments in the Field of Endoscopic Ultrasound for Diagnosis, Staging, and Treatment of Pancreatic Lesions

Endoscopic ultrasound (EUS) plays a crucial role in the diagnosis of both solid and cystic pancreatic lesions and in the staging of patients with pancreatic cancer through its use for tissue and fluid sampling. Additionally, in cases of precancerous lesions, EUS-guided therapy can also be provided. This review aims to describe the most recent developments regarding the role of EUS in the diagnosis and staging of pancreatic lesions. Moreover, complementary EUS imaging modalities, the role of artificial intelligence, new devices, and modalities for tissue acquisition, and techniques for EUS-guided treatment are discussed.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Full spectrum endoscopy for an easy and adequate visualization of Vater's papilla

Patients with classical familial adenomatous polyposis (FAP) are at high risk for developing colorectal cancer (CRC) and duodenal adenomas. Current guidelines recommend to start duodenal screening at the age of 25-30 years and standard upper gastrointestinal (GI) endoscopy is considered inadequate for an optimal visualization of the duodenum. We used the Full-Spectrum Endoscopy (R) (FUSE (R) ; EndoChoice Inc., Atlanta, GA, USA) esophagogastroduodenoscope (FUSE-EGD) for an upper GI screening procedure of a 20-year-old Caucasian male with classical FAP. The pioneer design of the FUSE-EGD allowed an easy and accurate examination of the ampulla with standard scope manipulation maneuvers

Adhering to quality medical care: a case report of upper gastrointestinal bleeding due to self-expandable metal stent placed for benign duodenal obstruction

Endoscopic placement of self-expandable metal stent (SEMS) is an efficient method for the palliative decompression of malignant gastro duodenal obstruction. However, its role in treating benign obstructive conditions is controversial. We herein present an unusual case of recurrent upper gastrointestinal (GI) bleeding episodes due to ischemic lesions induced by an uncovered SEMS placed several years before to treat post peptic ulcer pyloric obstruction. Patient's advanced age precluded any attempt for endoscopic or surgical removal of the stent and the patient was successfully treated only with proton pump inhibitors, remaining uneventful on the long term. 71 his case speaks to the need for rational use of innovative treatment modalities for quality of care provision

Strategies to Improve Inpatients’ Quality of Bowel Preparation for Colonoscopy: A Systematic Review and Meta-Analysis

Background and Aims. Inpatients’ bowel preparation before colonoscopy is frequently inadequate, and various interventions have been investigated to improve it, so far. We aimed to evaluate the efficacy of various interventions to improve inpatients’ colon preparation quality. Methods. We systematically reviewed the literature for publications on interventions aiming to improve the quality of inpatients’ colon preparation until June, 2018. Significant heterogeneity—measured with I2—was detected at the level of P<0.1. Adequacy rates were measured using inverse variance, and the size effect of different interventions was calculated using random effects model and expressed as odds ratio (OR). Results. Seventeen studies enrolling 2733 inpatients were included. Overall, 67% (60-75%) of the participants achieved adequate colon cleansing (I2=97%; P<0.001). In six studies assessing the impact of educational interventions to patient/physician/nurse vs. no intervention, adequate bowel preparation was achieved in 77% (62-91%) vs. 50% (32-68%) of the patients (OR 95%CI=3.49 (1.67-7.28), P=0.0009; I2=74%; P=0.002). Ten studies examined variations (qualitative and/or quantitative) in bowel preparation regimens with adequate preparation detected in 71% (60-81%) of the participants, and a single study examined the administration of preparation through an esophagogastroduodenoscope, resulting in adequate prep in 71% of the patients. Conclusions. Despite several interventions, only two-thirds of inpatients achieve adequate colon preparation before colonoscopy. Educational interventions significantly improve inpatients’ bowel preparation quality