Similar Clinical Success Rates Research Articles

Comparison of fully versus partially covered metal stents in endoscopic ultrasound-guided hepaticogastrostomy for malignant biliary obstruction (with video).

Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) using a fully covered metal stent (FCMS) or partially covered metal stent (PCMS) is performed to manage unresectable malignant biliary obstruction (MBO) following unsuccessful endoscopic retrograde cholangiopancreatography. This study aimed to compare FCMS and PCMS for EUS-HGS in patients with MBO. We reviewed the EUS database to analyze consecutive patients with MBO who underwent EUS-HGS between November 2017 and March 2023. We performed a 1:1 matching using propensity score matching based on potential confounding factors. Stent patency, technical success, clinical success, adverse events, reintervention, and overall survival were assessed. The technical success rate of EUS-HGS was 92% (123/134). A total of 80 patients with technical success (40 FCMS, 40 PCMS) were selected after propensity score matching. The two groups showed similar rates of clinical success (90% vs. 88%; P = 0.999), early adverse events (15% vs. 20%; P = 0.556), late adverse events (18% vs. 33%; P = 0.121), reintervention (20% vs. 38%; P = 0.084), and median overall survival (4.1 months [95% confidence interval (CI) 2.6-5.5] vs. 3.8 months [95% CI 1.9-5.7]; P = 0.609). During follow-up, the FCMS group showed higher patency rates (85% vs. 60% at 6 months; 76% vs. 43% at 12 months; P = 0.030). FCMS and PCMS for EUS-HGS in patients with unresectable MBO showed similar rates of clinical success, as well as early and late adverse events. However, the FCMS group showed a higher cumulative stent patency rate compared to the PCMS group.

Intermediate-dose Immune Tolerance Induction Outperforms with Faster Success, Less Bleeding and No Added Cost in Comparison with Low-dose: a Multicenter Randomized Clinical Trial

BackgroundLow-dose (LD) or intermediate-dose (MD) immune tolerance induction (ITI) are effective in severe hemophilia A (SHA) children with high-titer inhibitors (HTI) and are attractive in countries with economic constraints. However, high-quality evidence for their use is lacking. ObjectivesThis is a multicenter randomized clinical trial comparing the efficacy, safety and medication cost between LD-ITI and MD-ITI for SHA-HTI children. MethodsSHA children less than 8 year-age with historical/pre-ITI inhibitor-titer 5-200 Bethesda Units/mL in 3 centers were randomized 1:1 to receive LD-ITI (recombinant [r]FVIII 50 IU/kg every-other day) or MD-ITI (rFVIII 100 IU/kg/day) from January 2022 to June 2024 (ChiCTR2200056603, https://www.chictr.org.cn.). ResultsThirty-one patients (16 in MD-ITI, 15 in LD-ITI) were enrolled and followed for more than 24 months (median 26.9, range 24.0-29.5 months). The 2 groups had similar baseline clinical characteristics and similar success rate (93.8% [MD-ITI] vs. 86.7% [LD-ITI]). Compared to LD-ITI, MD-ITI patients took shorter median time to success (4.2 months vs. 10.1 months), to partial success (2.7 months vs. 6.6 months) and had lower mean rates for all bleeding (0.38/month vs. 1.40/month) and joint bleeding (0.11/month vs. 0.83/month). Between the 2 groups, although MD-ITI group had higher rFVIII consumption (12775 vs. 7680 IU/kg), their total medication costs to success were similar (3626.49 vs. 3240.38 US$/kg). ConclusionsFor SHA-HTI children, success rate and cost for MD-ITI and LD-ITI regimens were similar. MD-ITI regimen would be a priority for regions with economic constraints considering the shorter time to success, better bleeding control, and no increase in medication cost.

Root-filling materials for endodontic surgery: biological and clinical aspects.

The placement of root filling materials aims to prevent the occurrence of post-treatment apical periodontitis following completion of endodontic treatment. Materials should possess properties that will not permit bacterial invasion and infection, namely excellent sealing ability and/or antibacterial properties. In root-end filling procedures or repair of root perforations, the root filling materials are placed in a particularly challenging clinical environment, as they interface with a relatively large area with the periradicular tissues. The biological properties of these materials are therefore of significant importance. The current review discusses the most widely used materials for endodontic surgery (i.e., root-end filling and perforation repair), with particular focus on their biological characteristics, namely antibacterial properties and interactions with host tissue cells, together with clinical studies. Properties of amalgam, glass ionomer cements (GICs), resin systems, zinc oxide eugenol-based cements and hydraulic calcium silicate cements (HCSCs), together with representative and well-researched commercial materials in the context of their use in endodontic surgery are presented. While the use of HCSCs seems to offer several biological advantages, together with addressing issues with the initial formulation in the most recent versions, materials with different chemical compositions, such as zinc oxide eugenol-based cements, are still in use and appear to provide similar clinical success rates to HCSCs. Thus, the significance of the currently available materials on clinical outcomes remains unclear.

Comparison Between Static and Dynamic Spica Cast for Closed Reduction Cases of DDH: A Short-Term Follow-Up

Background: developmental dysplasia of the hip (DDH) is a typical childhood disease that, if left untreated, can lead to early-onset osteoarthritis. Closed reduction and spica casting are the first line of treatment for infants aged 6-18 months. Static and dynamic spica casts are the two primary treatment method used in practice, but the evidence is mixed as to which method provides the best outcomes. Methods: This prospective, randomized, controlled trial compared static and dynamic spica casting in 98 DDH patients from Kurdistan, Iraq. Patients were divided into dynamic and static groups. The hip was follow-up ed by using radiographic parameters such as the acetabular index and Tonnis grade. Treatment success was defined as a favorable hip outcome after one year. Results: There was no significant difference in treatment success between the groups, with 68% of patients in both groups achieving normal hip modification. However, the dynamic cast group had significantly better acetabular indices at 3, 6, and 12 months, and all of them were done under general anesthesia (GA), better hygiene, better caring and more comfortable parents with less cost. Conclusions: Static and dynamic spica casting have similar short-term clinical success rates for DDH, but dynamic casting produces better radiographic outcomes, especially in infants younger than 1. Longer-term studies are needed to determine possible radiographic improvement and whether dynamic type translate into better clinical outcomes since its more comfortable for parent, with less cost.

Calcium Silicate-Based Cements in Restorative Dentistry: Vital Pulp Therapy Clinical, Radiographic, and Histological Outcomes on Deciduous and Permanent Dentition-A Systematic Review and Meta-Analysis.

Vital pulp therapy aims to preserve the vitality of dental pulp exposed due to caries, trauma, or restorative procedures. The aim of the present review was to evaluate the clinical, radiographic, and histological outcomes of different calcium silicate-based cements used in vital pulp therapy for both primary and permanent teeth. The review included 40 randomized controlled trials from a search across PubMed, LILACS, and the Cochrane Collaboration, as well as manual searches and author inquiries according to specific inclusion and exclusion criteria. A critical assessment of studies was conducted, and after data extraction the results were submitted to a quantitative statistical analysis using meta-analysis. The studies, involving 1701 patients and 3168 teeth, compared a total of 18 different calcium silicate-based cements in both dentitions. The qualitative synthesis showed no significant differences in short-term outcomes (up to 6 months) between different calcium silicate-based cements in primary teeth. ProRoot MTA and Biodentine showed similar clinical and radiographic success rates at 6 and 12 months. In permanent teeth, although the global results appeared to be well balanced, ProRoot MTA generally seemed to perform better than other calcium silicate-based cements except for Biodentine, which had comparable or superior results at 6 months. Meta-analyses for selected comparisons showed no significant differences in clinical and radiographic outcomes between ProRoot MTA and Biodentine over follow-up periods. The present review highlights the need for standardized definitions of success and follow-up periods in future studies to better guide clinical decisions. Despite the introduction of new calcium silicate-based cements aiming to address limitations of the original MTA. ProRoot MTA and Biodentine remain the most used and reliable materials for vital pulp therapy, although the results did not deviate that much from the other calcium silicate-based cements. Further long-term studies are required to establish the optimal CSC for each clinical scenario in both dentitions.

Vital pulp therapies versus conventional endodontics for the treatment of mature teeth with pulp inflammation: A systematic review

Introduction: To compare the effectiveness of vital pulp therapies (pulpotomy and direct pulp capping) with that of conventional endodontics for the treatment of mature teeth with pulp inflammation and to analyze which pulp capping material is more effective for the treatment of mature teeth with pulp inflammation. Materials and Methods: A bibliographic search of electronic databases (PUBMED, COCHRANE LIBRARY, SCOPUS, ScienceDirect, and SciELo) was conducted. The inclusion criteria were comparative studies in patients who underwent conventional endodontic and vital pulp therapy in mature teeth with pulp inflammation and comparative studies comparing Mineral Trioxide Aggregate (MTA) versus calcium hydroxide as direct pulp capping materials in mature teeth with pulp inflammation. Risk of bias was assessed using RoB2 or ROBINS-I. Results: Eight clinical trials were included, all of which had a high risk of bias. The data analysis showed that pulpotomy has similar clinical success rates to conventional endodontics. No studies comparing conventional endodontics versus direct pulp capping were found. MTA has better clinical results than calcium hydroxide as a direct pulp capping material. Conclusion: Vital pulp therapies are a valid alternative for the treatment of mature teeth with pulp inflammation. There is a need for more clinical trials with longer follow-up time and which consider other variables related to the characteristics of the patient and the tooth.

Endoscopic ultrasound-guided drainage of pancreatic collections with dedicated metal stents: A nationwide, multicenter, propensity score-matched comparison

BackgroundThe new dedicated stents for endoscopic ultrasound (EUS)-guided transluminal drainage of peri‑pancreatic fluid collections (PFCs) demonstrated optimal efficacy and safety profiles. AimsThis study aimed to evaluate the safety, technical and clinical success, and recurrence rate of PFCs drained with Lumen Apposing Metal Stent (LAMS) or Bi-Flanged Metal Stent (BFMS). MethodsData from a multicenter series of PFCs treated with LAMS or BFMS at 30 Italian centers during a 5-year period were retrieved. The rate of adverse events (AEs), technical success, clinical success, PFC recurrence were evaluated. To overcome biases, a 1-to-1 match was created using propensity score analysis. ResultsOut of 476 patients, 386 were treated with LAMS and 90 with BFMS, with a median follow-up of 290 days (95% CI 244 to 361). Using propensity score matching, 84 patients were assigned to each group. The incidence of AEs did not differ between the two stents (13.1% versus 15.5%, p = 0.29), mainly bleeding or recurrence rate (4.7% versus 3.5%, p = 1). Technical and clinical success in the BFMS and LAMS groups were 92% versus 95% (p = 0.36) and 91% versus 94% (p = 0.64), respectively. ConclusionOur study demonstrates that LAMS and BFMS have comparable safety profiles with similar technical and clinical success rates for EUS-guided PFC drainage.

A Meta-Analysis of Endoscopic Stenting Versus Surgical Treatment for Malignant Gastric Outlet Obstruction.

Surgical gastrojejunostomy (GJJ) and endoscopic stenting (ES) are the two most available treatments for palliation of malignant gastric obstruction (MGOO). The aim of this study is to compare these two techniques regarding efficacy, safety, time of hospitalization and survival. We performed a literature search from January 2010 to September 2020 to identify available randomized controlled studies and observational studies that compared ES and GJJ for the treatment of MGOO. A total of 17 studies were found. ES and GJJ showed similar technical and clinical success rate. ES was superior to obtain early oral re-feeding, shorter length of hospitalization and a lower incidence of complications than GJJ. Surgical palliation had a lower recurrence rate of obstructive symptoms and longer overall survival than ES. Both procedures have advantages and disadvantages. Probably we should not find the best palliation but the best approach based on the patient characteristics and tumor type.

EUS-Guided gallbladder drainage vs percutaneous transhepatic drainage in patients with acute cholecystitis: a systematic review and meta-analysis

Occasionally, cholecystectomy is not possible because the patient is not suitable for surgery, and non-operative management should be performed. In these patients, the non-operative management can be through the percutaneous transhepatic gallbladder drainage (PTGBD) or the endoscopic gallbladder drainage. We decided to compare the efficacy and safety of PTGBD and EUS-GBD in the non-operative management of patients with acute cholecystitis. We conducted a systematic review in different databases, such as PubMed, OVID, Medline, and Cochrane Databases. This meta-analysis considers studies published until September 2021. Six studies were selected (2 RCTs). These studies included 749 patients. The mean age was 72.81 ±7.41 years, and males represented 57.4%. EUS-GBD technical success was lower than PTGBD (RR, 0.97; 95% CI, 0.95-0.99), whereas clinical success and adverse events rates were similar in both groups. Twenty-one deaths were reported in all six studies. The global mortality rate was 2.80%, without differences in both groups (2.84% and 2.77% in the EUS-GBD group and the PTGBD groups, respectively). EUS-GBD and PTGBD were successful techniques for gallbladder drainage in patients with acute cholecystitis who are non-tributary for surgery. EUS-GBD has a similar clinical success rate and a similar adverse events rate in comparison to PTGBD. The high technical success and the low adverse events rate of the EUS approach to gallbladder make this technique an excellent alternative for patients with acute cholecystitis who cannot be undergoing surgery.

Palliative therapy for malignant gastric outlet obstruction: how does the endoscopic ultrasound-guided gastroenterostomy compare with surgery and endoscopic stenting? A systematic review and meta-analysis.

The gold-standard procedure to address malignant gastric outlet obstruction (MGOO) is surgical gastrojejunostomy (SGJJ). Two endoscopic alternatives have also been proposed: the endoscopic stenting (ES) and the endoscopic ultrasound-guided gastroenterostomy (EUS-G). This study aimed to perform a thorough and strict meta-analysis to compare EUS-G with the SGJJ and ES in treating patients with MGOO. Studies comparing EUS-G to endoscopic stenting or SGJJ for patients with MGOO were considered eligible. We conducted online searches in primary databases (MEDLINE, EMBASE, Lilacs, and Central Cochrane) from inception through October 2021. The outcomes were technical and clinical success rates, serious adverse events (SAEs), reintervention due to obstruction, length of hospital stay (LOS), and time to oral intake. We found similar technical success rates between ES and EUS-G but clinical success rates favored the latter. The comparison between EUS-G and SGJJ demonstrated better technical success rates in favor of the surgical approach but similar clinical success rates. EUS-G shortens the LOS by 2.8 days compared with ES and 5.8 days compared with SGJJ. Concerning reintervention due to obstruction, we found similar rates for EUS-G and SGJJ but considerably higher rates for ES compared with EUS-G. As to AEs, we demonstrated equivalent rates comparing EUS-G and SGJJ but significantly higher ones compared with ES. Despite being novel and still under refinement, the EUS-G has good safety and efficacy profiles compared with SGJJ and ES.

Long-term outcomes of endoscopic ultrasound-guided gallbladder drainage versus insitu or ex situ percutaneous gallbladder drainage in real-world practice.

Many studies showed better outcomes of endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) when compared with percutaneous transhepatic gallbladder drainage (P-GBD) in which most tubes were left insitu. However, no studies have directly compared EUS-GBD with P-GBD after tube removal (ex situ). We compared the long-term outcomes of EUS-GBD and ex situ or insitu P-GBD in high surgical risk patients with acute cholecystitis. We reviewed the records of 182 patients (EUS-GBD, n=75; P-GBD, n=107) who underwent gallbladder drainage. The procedural outcomes, long-term outcomes, and adverse events were compared. The EUS-GBD group and the P-GBD group had similar rates of technical and clinical success. Early adverse events were less common in the EUS-GBD group (5.5% vs. 18.9%, P=0.010). The long-term outcomes were evaluated in 168 patients (EUS-GBD, n=67; P-GBD ex situ, n=84; P-GBD insitu, n=17). The rate of cholecystitis recurrence in the EUS-GBD group (6.0%) was similar to that in the P-GBD ex situ group (9.6%, P=0.422), but significantly lower than that in the P-GBD insitu group (23.5%, P=0.049). P-GBD insitu was a significant predictor of recurrent cholecystitis (hazard ratio 14.6; 95% confidence interval 2.9-72.8). The long-term recurrence rate of acute cholecystitis in patients who underwent EUS-GBD was comparable to that in patients whose P-GBD could be removed. However, patients in whom P-GBD could not be removed showed higher rates of recurrent cholecystitis than patients with EUS-GBD.

Radiation exposure and clinical outcome in patients undergoing percutaneous intradiscal ozone therapy for disc herniation: Fluoroscopic versus conventional CT guidance.

To compare technical success, clinical success, complications and radiation dose for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation using fluoroscopic guidance versus conventional computed tomography (CT) guidance. Between March 2018and March 2021, 124consecutive percutaneous intradiscal ozone therapies wereperformedon111 patients with low back pain (LBP) and/or sciatic pain due to lumbar disc herniation, using fluoroscopic or conventional CT guidance, respectively in 53 and 58 herniated lumbar discs, with at least 1-month follow up. Dose area product (DAP) and dose length product (DLP) were recorded respectively for fluoroscopy and CT, and converted to effective dose (ED). Fluoroscopic and CT groups were similar in terms of patient age (p-value 0.39), patient weight (p-value 0.49) and pre-procedure Oswestry Disability Index (ODI, p-value 0.94). Technical success was achieved in all cases. Clinical success was obtained in 83.02% (44/53) patients in fluoroscopic group and 79.31% (46/58) in CT group. Mean DAP was 11.63Gy*cm2 (range 5.42-21.61). Mean DLP was 632.49mGy-cm (range 151.51-1699). ED was significantly lower in the fluoroscopic group compared toCT group (0.34 vs. 5.53mSv, p = 0.0119). No major complication was registered. Minor complications were observed in 4 cases (2 in fluoroscopic group; 2 in CT group). Compared to conventional CT guidance, fluoroscopic guidance for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation shows similar technical and clinical success rates, with lower radiation dose. This technique helps sparing dose exposure to patients.

Intradiscal ozone therapy: fluoroscopic guidance reduces operative time in comparison with CT guidance in patients with lumbar disc herniation.

To compare clinical success and operative time for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation using fluoroscopic guidance versus computed tomography (CT). During the year 2019, 68 percutaneous single-level intradiscal ozone therapies were performed on patients complaining of low back pain and/or sciatica due to lumbar disc herniation, using fluoroscopic or conventional CT guidance, respectively, in 35 and 32 herniated lumbar discs, with at least 1-month follow-up. Oswestry Disability Index (ODI) was used to assess clinical outcome. Total room utilization time and procedure operative time were recorded for both fluoroscopy and CT guidance. Fluoroscopy and CT groups were similar in terms of patient age (p value 0.45) and pre-procedure ODI (p value 0.64). Clinical success was obtained in 87.50% (28/32) patients in fluoroscopic group and 83.33% (30/36) in CT group. Mean total room utilization time was significantly longer for CT guidance (31.38 vs. 50.67min, p < 0.0001), as well as the procedure operative time (15.94 vs. 27.61min, p < 0.0001). Compared to conventional CT guidance, fluoroscopic guidance for percutaneous intradiscal ozone therapy in patients with lumbar disc herniation shows similar clinical success rates at 1-month follow-up, with decreased room utilization time and procedure operative time that implies less time consumption for medical and paramedical operative team.

Clinical Radiographic Evaluation of 3Mixtatin and MTA in Primary Teeth Pulpotomies: A Randomized Controlled.

IntroductionThe present study evaluates the efficiency of 3Mixtatin (a combination of Simvastatin and 3Mix antibiotics) in comparison with Mineral Trioxide Aggregate in primary molars pulpotomy.Materials and methodsA total of 64 deciduous molar teeth with caries requiring pulpotomy procedure were selected and randomly divided into two treatment groups, Group I- MTA (n = 32), Group II- 3Mixtatin (n = 32). Restoration with Glass Ionomer Cement followed by stainless steel crowns was done after pulpotomy procedure. The clinical and radiographical analysis was done in the subsequent follow-up periods of 3, 6, 9, and12 months simultaneously.ResultBoth groups showed equal success rates, without any significant difference between the MTA and 3mixtatin groups clinically (success rate of 93.8%)and radiographically higher success rate was seen with 3Mixtatin (78% success rate).Conclusion3mixtatin showed similar clinical and better radiographical success rate to MTA. Therefore, 3mixtatin may be a potential alternate pulpotomy medicament in primary teeth.Key messagesIn the present study based on the radiographic findings, 78% success rate was seen in the teeth treated with 3Mixtatin, which was higher than the radiographic success rate of MTA (75%). Therefore, it is reasonable to assume the use of 3Mix with Simvastatin to treat pulpotomized primary molars by 3Mixtatin.How to cite this articleChak RK, Singh RK, Mutyala J, et al. Clinical Radiographic Evaluation of 3Mixtatin and MTA in Primary Teeth Pulpotomies: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(S-1):S80–S86.

Over-the-Scope Clip Applications as First-Line Therapy in the Treatment of Upper Non-variceal Gastrointestinal Bleeding, Perforations, and Fistulas.

BackgroundThe over-the-scope clip (OTSC) is an innovative device and has been successfully used in endoscopic treatment, however, there is a lack of clinical data from China. The aim of this study is to investigate the OTSC applications in the treatment of upper non-variceal gastrointestinal bleeding (UNVGIB), perforations, and fistulas in China.MethodsIn total, 80 patients were treated with one OTSC respectively as first-line therapy in our endoscopy center between January 2016 and November 2020. Among them, 41 patients had UNVGIB, 34 patients had perforations, and five patients had fistulas. The technical and clinical success rates were used to assess the efficacy of OTSC on the above diseases. In addition, we compared the hemostatic efficacy of OTSC with the standard endoscopic therapy in ulcer bleeding and Dieulafoy's lesion by propensity score matching analysis.ResultsIn general, the OTSCs were applied successfully in all patients and achieved 100% (80/80) technical success. The clinical success of all patients was 91.3% (73/80). Among 41 patients with UNVGIB, the clinical success was 85.4% (35/41); 6 patients presented with recurrence. For patients of Dieulafoy's lesion and under antithrombotic therapy, we found that OTSC treatment had both efficient and reliable hemostasis effects. In addition, according to the characteristics of ulcers, site of bleeding lesion, and Blatchford score, all patients received similar and reliable clinical success rates. After propensity score matching, we found that OTSC treatment had low rebleeding rates when compared with standard endoscopic therapy in both Dieulafoy's lesion (15.0 vs 30.0%) and ulcer bleeding (17.6 vs 29.4%). Among 34 patients with perforations, the clinical success was 100% (34/34). Among five patients with fistulas, only one patient failed in maintaining the OTSC before esophageal fistula healing, and the clip achieved an overall clinical success of 80% (4/5).ConclusionThe OTSC represents a safe and effective endoscopic therapy for UNVGIB, perforations, and fistulas as first-line treatment, especially for Dieulafoy's lesion or patients under antithrombotic therapy for UNVGIB, etc. However, OTSC application in these specific lesions or patients lacks adequate evidence as first-line treatment. Therefore, further larger sample and multi-center clinical trials are required to improve its indications in clinical treatment.

Cone beam computed tomography (CBCT) guidance is helpful in reducing dose exposure to pediatric patients undergoing radiofrequency ablation of osteoid osteoma

PurposeTo assess efficacy and safety of cone beam computed tomography (CBCT) in the radiofrequency ablation (RFA) of osteoid osteoma (OO) in children and adolescents, and to compare technical success, clinical success, radiation dose and procedure duration time of CBCT guidance to conventional computed tomography (CT) guidance.Materials and methodsBetween 2015 and 2019, 53 consecutive percutaneous RFA were performed on pediatric patients with CBCT or conventional CT guidance, respectively, in 24 and 29 children and adolescents with 24-month follow-up. Dose area product (DAP) and dose length product (DLP) were recorded, respectively, for CBCT and conventional CT and converted to effective doses (ED).ResultsCBCT and conventional CT groups were similar in terms of patient age and weight, tumor size and tumor location. Technical success was achieved in all cases. Primary clinical success was 91.67% (22/24) for the CBCT group and 89.66% (26/29) for the conventional CT group. Mean DAP was 64.75Gycm2 (range 6.0–266.7). Mean DLP was 972.62mGycm (range 337–2344). ED was significantly lower in the CBCT group compared to the conventional CT group (0.34 mSv vs. 5.53 mSv, p = 0.0119). Procedure duration time was not significantly longer in the CBCT group (102.25 min vs. 92.34 min, p = 0.065). No major complication was registered. Minor complications were observed in 4 patients (2 in CBCT; 2 in conventional CT).ConclusionsCompared to conventional CT guidance, CBCT guidance for percutaneous OO ablation shows similar technical and clinical success rates, with reduced radiation dose and equivalent procedure duration time. This technique helps sparing dose exposure to pediatric patients.

Biliary drainage in inoperable malignant biliary distal obstruction: A systematic review and meta-analysis.

BACKGROUNDEndoscopic drainage remains the treatment of choice for unresectable or inoperable malignant distal biliary obstruction (MDBO). AIMTo compare the safety and efficacy of plastic stent (PS) vs self-expanding metal stent (SEMS) placement for treatment of MDBO. METHODSThis meta-analysis was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A comprehensive search was performed in MEDLINE, Cochrane, Embase, Latin American and Caribbean Health Sciences Literature, and grey literature to identify randomized clinical trials (RCTs) comparing clinical success, adverse events, stent dysfunction rate, reintervention rate, duration of stent patency, and mean survival. Risk difference (RD) and mean difference (MD) were calculated and heterogeneity was assessed with I2 statistic. Subgroup analyses were performed by SEMS type. RESULTSTwelve RCTs were included in this study, totaling 1005 patients. There was no difference in clinical success (RD = -0.03, 95% confidence interval [CI]: -0.01, 0.07; I2 = 0%), rate of adverse events (RD = -0.03, 95%CI: -0.10, 0.03; I2 = 57%), and mean patient survival (MD = -0.63, 95%CI: -18.07, 19.33; I2 = 54%) between SEMS vs PS placement. However, SEMS placement was associated with a lower rate of reintervention (RD = -0.34, 95%CI: -0.46, -0.22; I2 = 57%) and longer duration of stent patency (MD = 125.77 d, 95%CI: 77.5, 174.01). Subgroup analyses revealed both covered and uncovered SEMS improved stent patency compared to PS (RD = 152.25, 95%CI: 37.42, 267.07; I2 = 98% and RD = 101.5, 95%CI: 38.91, 164.09; I2 = 98%; respectively). Stent dysfunction was higher in the covered SEMS group (RD = -0.21, 95%CI: -0.32, -0.1; I² = 205%), with no difference in the uncovered SEMS group (RD = -0.08, 95%CI: -0.56, 0.39; I² = 87%).CONCLUSIONWhile both stent types possessed a similar clinical success rate, complication rate, and patient-associated mean survival for treatment of MDBO, SEMS were associated with a longer duration of stent patency compared to PS.

Comparison of Three Methods of Gallbladder Drainage for Patients with Acute Cholecystitis Who Are at High Surgical Risk: A Network Meta-Analysis and Systematic Review.

Background: Percutaneous gallbladder drainage (PTGBD), endoscopic ultrasound-guided gallbladder drainage (EUSGBD), and endoscopic transpapillary gallbladder drainage (ETGBD) are used for the treatment of patients with acute cholecystitis who are at high surgical risk. However, it is unclear which procedure is associated with the best outcomes. Methods: We systematically searched records in PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov up to March 1, 2020. Studies that compared at least two of PTGBD, ETGBD, and EUSGBD were included. Results: A total of 13 studies were included in the present analyses. PTGBD, EUSGBD, and ETGBD were associated with similar clinical success, adverse event, recurrent cholecystitis, reintervention, and mortality rates. PTGBD was associated with a higher technical success rate than EUSGBD (odds ratio [OR] = 0.75, 95% confidence interval [CI] = 0.40-1.41) or ETGBD (OR = 0.73, 95% CI = 0.35-1.53). EUSGBD was associated with the highest probability of clinical success (67.5%), and the lowest prevalences of adverse events (57.0%) and recurrent cholecystitis (60.9%). ETGBD was associated with the best reintervention outcomes (81.8%). Conclusions: Compared with PTGBD and ETGBD, EUSGBD appears to be preferable with respect to both safety and efficacy for the treatment of patients with acute cholecystitis who are at high surgical risk.

Unilateral versus bilateral hilar stents for the treatment of cholangiocarcinoma: a multicenter international study.

BackgroundEndoscopic placement of hilar stents is an accepted palliative therapy for patients with advanced, unresectable cholangiocarcinoma. However, whether unilateral versus bilateral stent placement provides optimal relief continues to be a subject of debate. The aim of this study was to compare the technical and clinical outcomes in patients with inoperable cholangiocarcinoma who received unilateral or bilateral self-expanding metal stents (SEMS).MethodsWe conducted a multicenter, international retrospective study of 187 patients with cholangiocarcinoma who received unilateral or bilateral SEMS. Outcomes included, but were not limited to, technical success, clinical success, adverse events, stent occlusion, and survival time. Results were further stratified based on the Bismuth classification.ResultsFifty patients received unilateral stents and 137 patients received bilateral stents. All patients achieved technical success. The clinical success rates were 86% for unilateral stents and 82.5% for bilateral stents (P>0.99). Clinical success was not statistically different for either group when stratified by the Bismuth classification (P=0.62 and P=0.72 respectively). There were significantly more adverse events in the bilateral stents group (11.7% vs. 0%, P=0.007). There was no greater risk of stent occlusion when bilateral stents were used (unadjusted P=0.71, adjusted P=0.81). There was a greater risk of death for patients who received bilateral SEMS (hazard ratio 1.78, 95% confidence interval 1.09-2.89; P=0.02).ConclusionsUnilateral and bilateral drainage had similar technical and clinical success rates. However, bilateral stents had a higher risk of death and more adverse events. Therefore, unilateral SEMS placement is sufficient for relief of biliary obstruction secondary to cholangiocarcinoma.

Acute and early EUS-guided transmural drainage of symptomatic postoperative fluid collections

EUS-guided postoperative drainage (EUS-POD) of postoperative fluid collections (POFCs) is typically delayed until a thick wall has formed to optimize safety. Thus, percutaneous drainage is the mainstay of early POFC management. The primary aim of this study was to compare technical and clinical success and adverse event (AE) rate between early (0-30 days postoperative) compared with delayed (>30 days) EUS-POD. The secondary aim was to determine predictors for clinical success and AE rate associated with early compared with delayed EUS-POD. This was a retrospective analysis of consecutive patients undergoing EUS-POD between November 2013 and November 2018 at a single tertiary academic center. Demographic, procedural, and outcomes data were recorded. Clinical success was defined as resolution of symptoms and the fluid collection on cross-sectional imaging without recurrence after transluminal stent removal. Seventy-five patients underwent EUS-POD; 42 (56%) were early, of whom 20 were acute. Sixty-three patients (84%) had undergone distal pancreatectomy. Technical success was 100%, and clinical success was achieved in 70 patients (93%) after a mean 2.2 procedures (range, 1-5). Prior percutaneous drainage had been performed in 13 patients (17.3%). Both acute and early drainage versus delayed EUS-POD demonstrated similar rates of clinical success (95% and 93% vs 94%, P= .99) and AEs (21.4% and 15% vs 30.3%, P= .43). Necrosectomy was required less often in the early versus the delayed group. No predictors of clinical success were identified. Early EUS-POD was not a predictor of AEs (P= .65). Infection and collection size >10 cm correlated with increased AE risk (P=.048 and .007, respectively). Early and even acute EUS-POD of POFCs appears to be technically feasible, clinically effective, andsafe. EUS-POD should be considered for definitive management of early symptomatic POFCs.