Updated Systematic Review Research Articles

Efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) vs percutaneous transhepatic biliary drainage (PTBD) for cholangiocarcinoma biliary obstruction: An updated systematic review and meta analysis.

557 Background: Perioperative and/or palliative biliary drainage for the management of cholangiocarcinoma biliary obstruction has been part of the backbone of the multidisciplinary approach that this condition requires. For both intrahepatic and perihilar cholangiocarcinoma, ERCP and PTBD are the two main techniques available. There has yet to be consensus favoring one approach over the other. Methods: Following the PRISMA guidelines, a systematic review and meta-analysis were performed to determine if there was a difference in efficacy and safety of ERCP compared to PTBD for Cholangiocarcinoma Biliary Obstruction. Primary outcomes were successful biliary drainage, mean number of needed procedures, length of stay and overall adverse events rate. Data were analyzed using R version 4.2.2. The risk of bias was assessed by the Robins-I and RoB 2 tool. The quality of evidence was graded using the GRADE scale and Newcastle-Ottawa guidelines. Results: Three randomized clinical trials and two observational studies described the successful biliary drainage rate of ERCP vs PTBD for cholangiocarcinoma associated biliary obstruction, totaling 340 patients. Meta-analysis test for overall effect, showed no statistical difference between groups (RR = 0.88; 95% CI = [0.69; 1.13]; p = 0.23; Fig. 1). Similarly, in terms of the mean number of needed procedures per patient, a total of three randomized clinical trials and two observational studies, totaling 340 patients were included, no statistically significant difference was found (SMD = 0.64; 95% CI = [- 9.36; 10.63]; p = 0.57; Fig. 2). Likewise, one randomized clinical trial and two observational studies showed no statistically significant difference on the length of stay (days) mean between groups (SMD = 0.06; 95% CI = [- 1.57; 1.68]; p = 0.73; Fig. 3). Although, the three clinical trials and three observational studies showed a mild decreased adverse event and death (within 3 months) rate in the ERCP group, after undergoing statistical analysis, meta-analysis test for overall effect, showed no statistical difference (RR = 0.99; 95% CI = [0.55; 1.77]; p = 0.97; Fig. 4 and RR = 0.61; 95% CI = [0.10; 3.87]; p = 0.22; Fig. 5, respectively). The risk of bias was low with moderate-to-high quality of evidence amongst the included studies. Conclusions: Our updated systematic review and meta-analysis demonstrated no statistically significant difference in the successful biliary drainage rate, mean number of needed procedures, length of stay, death within 3 months and adverse event rate between ERCP vs PTBD for management of cholangiocarcinoma biliary obstruction. Further randomized studies are needed to confirm these findings.

Prevalence of multiple sclerosis in Brazil: An updated systematic review with meta-analysis.

The prevalence of multiple sclerosis has been increased worldwide. However, no update on the prevalence of multiple sclerosis in Brazil has been conducted since 2015 OBJECTIVE: The aim of the present review is to perform an update of the multiple sclerosis prevalence in Brazil as well as to analyze its current epidemiological profile METHODS: We searched for studies on the multiple sclerosis prevalence in Brazil. The databases researched were Medline (PubMed), Embase, Scielo, Scopus and Web of Science using the keywords "prevalence", "prevalence study", "incidence", "epidemiology", "multiple sclerosis" and "Brazil" RESULTS: Eleven studies were included for descriptive and quantitative analysis. The pooled prevalence of multiple sclerosis in Brazil estimates 14.5 cases per 100.000 inhabitants. It is more prevalent in white people (74 %) and female (76.3 %). The most prevalent clinical form is the relapsing-remitting form (80.2 %), followed by the secondary progressive form (13 %) and by the primary progressive form (6.8 %) CONCLUSION: Although the prevalence of multiple sclerosis in Brazil varies substantially between regions, it is in accordance with what is known in the world. However, there is a lack of recent epidemiological studies of multiple sclerosis in Brazil and more studies are needed for better accuracy and comprehension of its prevalence.

Unilateral versus bilateral pedicle screw fixation in minimally invasive transforaminal lumbar interbody fusion: a systematic review and meta-analysis of randomized controlled trials.

The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) that adopts paramedian incisions and tubular retractors to perform the decompression and interbody fusion has been widely used in the surgery for lumber degenerative disease (LDD). Bilateral pedicle screw fixation (BPSF) and unilateral pedicle screw fixation (UPSF) are the primary fixing techniques in MIS-TLIF. We conducted an updated systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the efficacy and safety between UPSF and BPSF in patients undergoing MIS-TLIF surgery for LDD. We searched the PubMed, Embase, and Cochrane Library databases for potential RCTs till June 2023. The effects of the fixation methods on clinical outcomes were estimated using the odd ratio (RR), risk difference (RD), and mean difference (MD) with a 95% confidence interval (CI) and a random-effects model. We obtained six RCTs. There was no significant difference between UPSF and BPSF in fusion rate, hospitalization day, low back pain, leg pain, Oswestry Disability Index, and SF-36 for physical functioning at 3-6months and ≥ 6months after surgery. Neither the total complication nor the individual complications showed differences between the two methods. However, UPSF significantly decreased operation time (MD = -39.05; 95% CI: -53.50 to -24.67) and estimated blood loss (MD = -60.41; 95% CI: -79.09 to -41.73) compared with BPSF. UPSF is better than BPSF when operation time and estimated blood loss are considered. BPSF may be considered for patients with single-level LDD without high-grade spondylolisthesis.

Enteral and parenteral nutrition in patients with cancer: complication rates compared—updated systematic review and meta-analysis

BackgroundThe aim of this systematic review and meta-analysis is to compare the complication rates of enteral nutrition (EN) (oral or tube feeding (TF)) and parenteral nutrition (PN) in patients with...

Normothermic Machine Perfusion vs. Static Cold Storage in Liver Transplantation: A Systematic Review and Meta-Analysis.

Normothermic machine perfusion (NMP) represents an alternative to prolong liver preservation and reduce organ discard rates. We performed an updated systematic review and meta-analysis to compare NMP with static cold storage (SCS) in liver transplantation. MEDLINE, Embase, and Cochrane were searched for randomized controlled trials (RCTs) or observational studies. Risk ratios (RR) and mean differences were calculated. p < 0.05 was considered significant. A random-effects model was applied for all outcomes. CRD42023486184. We included 1295 patients from 5 RCTs and 6 observational studies from 2016 to 2023. 592 (45.7%) underwent NMP. A subgroup RCT analysis favored NMP for non-anastomotic strictures (RR 0.4; 95% CI 0.2, 0.9), postreperfusion syndrome (RR 0.4; 95% CI 0.27, 0.56), and early allograft dysfunction (RR 0.6; 95% CI 0.4, 0.9). NMP favored higher organ utilization rates (RR 1.1; 95% CI 1.02, 1.18). No significant differences between NMP and SCS were observed in graft survival or patient survival at 12 months, primary non-function, serious adverse events, overall biliary complications, AST, or bilirubin levels peak within the first 7 days, ICU or hospital length of stay. Our findings suggest that NMP is associated with lower non-anastomotic biliary stricture rates, postreperfusion syndrome, early allograft dysfunction, and higher organ utilization in the RCT subgroup analysis, without increasing adverse events.

Intracardiac or transesophageal echocardiography for left atrial appendage occlusion? an updated systematic review and meta-analysis

Abstract Background Percutaneous left atrial appendage occlusion (LAAO) is typically performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. Intracardiac echocardiography (ICE) appears to be a potential alternative to guide implantation. Purpose We sought to perform a meta-analysis comparing ICE vs TEE for the guidance of percutaneous LAAO. Methods A comprehensive literature search was performed using MEDLINE, Scopus and Web of Science electronic databases from their inception to November 2023 regarding published abstracts and manuscripts. Studies reporting clinical outcomes comparing ICE vs TEE for percutaneous LAAO were included. Primary efficacy and safety outcomes included technical success and the occurrence of any reported procedure-related and device-related complication. Secondary outcomes included procedural characteristics such as procedural time, fluoroscopy time and the volume of contrast agent used. Results A total of 18 studies with 124,230 patients fulfilled the criteria. Outcomes assessed including procedure time between ICE vs TEE (risk ratio [RR], 1.01; 95% CI, 1.00-1.01), fluoroscopy time (MD: 1.45 minutes, 95% CI -1.32 to 4.22, p=0.30) and contrast medium volume (SMD: 0.02, 95% CI -0.23 to 0.26, p=0.89) were found to be similar between both groups. Technical success with higher odds was found with the use of ICE (OR: 1.36, 95% CI 1.14 to 1.63, p=0.006) and fewer devices employed in cases of ICE guidance (SMD: -0.22, 95% CI -0.43 to -0.01, p=0.04, I2=62%). There was also no significant difference in procedure- or device-related adverse events between both groups. Interestingly, patients undergoing LAAO under ICE guidance had higher risk for pericardial effusion/tamponade and iatrogenic residual shunts compared to those in the TEE group (11 studies, RR: 1.66, 95% CI 1.13 to 2.43, p=0.014) and (4 studies, RR: 1.53, 95% CI 1.12 to 2.09, p=0.02, I2=1%), respectively. More vascular complications were noted in cases of ICE (RR: 1.56, 95% CI 1.06 to 2.32, p=0.03). Conclusions Although TEE is the gold standard for perioperative guidance of LAAO, imaging with ICE is an effective alternative to TEE in LAAO procedures. However, further studies are needed to clarify safety of this new perioperative imaging technique.

P-1570. D-mannose for Prevention of Recurrent Urinary Tract Infection in Adult Women: An Updated Systematic Review and Meta-analysis

Abstract Background Urinary tract infections (UTIs) are prevalent, especially among women as approximately 50% of all healthy women will encounter at least one episode of UTI during their lifetime. An estimated 25%-35% of them will experience a recurrence within the following year. Prolonged antibiotic therapy for prophylaxis of UTI poses the risk of antimicrobial resistance, alteration of normal flora, and high costs to the patient. D-mannose, a polysaccharide may reduce UTI by preventing the adherence of bacteria to uroepithelium by binding to the type1 pili and saturating the adhesin FimH. D-mannose is commonly marketed for urinary tract health and is touted to contribute to better antimicrobial management within primary care settings. We performed an updated meta-analysis comparing prophylaxis with D-mannose versus placebo or no treatment for prevention of recurrent UTI in adult women. Methods We systematically searched PubMed, Scopus, and Cochrane Central databases for trials comparing D-mannose versus placebo or no treatment for UTI prophylaxis in adult women. Outcomes of interest included one or more episodes of UTI within 6 months of randomization and adverse events. Statistical analysis was performed using R software. Heterogeneity was assessed using I2 statistics. The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline (Figure 1). Risk estimation for recurrent UTI Results The systematic review identified three randomized controlled trials including 846 participants. Prophylaxis with D-mannose was given to 428 (50.59%) participants. The risk of recurrent UTI within 6 months of randomization (RR 0.75; 95%CI 0.46-1.23; p=0.259; I2=52%) showed no significant difference between the groups (Figure 2). Adverse events (RR 0.81; 95%CI 0.09-6.91; p=0.847; I2=94%) were also similar between the groups (Figure 3). Risk estimation for adverse events Conclusion In contrast to a previous meta-analysis, our study found that prophylaxis with D-mannose did not reduce the risk of recurrent UTIs in adult women. Adverse events were also comparable between the groups. Disclosures All Authors: No reported disclosures

Myriads of updated systematic reviews and meta-analyses - Should trial sequential and power-analysis be mandatory?

Myriads of updated systematic reviews and meta-analyses - Should trial sequential and power-analysis be mandatory?

Child Transmission of SARS-CoV-2 Throughout the Pandemic: An Updated Systematic Review and Meta-Analysis.

This systematic review sought to characterize child-to-child and child-to-adult transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2). A systematic review was conducted from April 1, 2021, to December 15, 2023, to estimate secondary attack rates (SARs) and secondary infections per index case (case rate) from index cases up to age 20 years. SAR and case rate were analyzed based on age, setting, country and variant prevalence. Meta-analysis was conducted on the SAR data. Eighty-six studies were included, representing 33,674 index cases. The total pooled SAR was 0.11 (95% CI: 0.07-0.16); 0.05 (95% CI: 0.03-0.10) for child-to-child transmission and 0.15 (95% CI: 0.07-0.30) for child-to-adult transmission. Pooled SAR in households was 0.28 (95% CI: 0.24-0.34) and was 0.02 (95% CI: 0.01-0.04) in schools. The role of children in SARS-CoV-2 transmission is small, particularly in schools. This work can help inform policies that effectively reduce transmission while minimizing adverse effects on children.

Robotic versus laparoscopic colorectal surgery for patients with obesity: an updated systematic review and meta-analysis.

Obesity poses significant challenges in colorectal surgery, affecting operative difficulty and postoperative recovery. The choice of minimally invasive approach for this patient population remains a challenge during preoperative planning. This review aims to provide an updated synthesis of studies comparing laparoscopic and robotic approaches for adult patients with obesity undergoing colorectal surgery. MEDLINE, Embase and CENTRAL were searched up to August 2023. Articles were included if they compared laparoscopic and robotic colorectal surgery outcomes in adults with obesity (BMI ≥30 kg/m2). Outcomes included overall postoperative morbidity, conversion to laparotomy, and operative time. Inverse variance random-effects meta-analyses were used to pool effect estimates. After screening 2187 citations, 10 observational studies were included with 3281 patients with obesity undergoing robotic surgery (mean age: 58.1 years, female: 43.9%) and 11 369 patients with obesity undergoing laparoscopic surgery (mean age: 58 years, female: 53.2%). Robotic surgery resulted in longer operative times (MD 46.71 min, 95% CI 33.50-59.92, p < 0.01, I2 = 93.79%) with statistically significant reductions in conversions to laparotomy (RR 0.50, 95% CI 0.39-0.65, p < 0.01, I2 = 67.15%). No significant differences were seen in postoperative morbidity (RR 0.94, 95% CI 0.82-1.08, p = 0.40, I2 = 36.08%). These data suggest that robotic colorectal surgery in patients with obesity may reduce the risk for conversion to laparotomy, but at the expense of increased operative times and with no overt benefits in postoperative outcomes. Further high quality randomized controlled trials assessing the utility of robotic surgery in patients with obesity undergoing colorectal surgery are warranted.

The association between maternal diabetes and the risk of attention deficit hyperactivity disorder in offspring: an updated systematic review and meta-analysis.

Mixed results have been reported regarding the link between different types of maternal diabetes and attention deficit hyperactivity disorder (ADHD) in offspring. Hence, we conducted a systematic review and meta-analysis to explore these associations. Relevant studies on the subject were retrieved from six major databases, including PubMed, Medline, Embase, Scopus, CINAHL, and PsychINFO. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale, and between-study heterogeneity was assessed using the I2 statistic. Subgroup, sensitivity, and meta-regression analyses were conducted to identify the sources of heterogeneity between studies. In total, seventeen observational studies (five case-control and twelve cohort studies) with 18,063,336 study participants were included in the final analysis. Our random-effects meta-analysis revealed that exposure to any form of maternal diabetes was associated with an increased risk of ADHD in children. Specifically, we observed a heightened risk of ADHD in children exposed to gestational diabetes mellitus, any pre-existing diabetes, pre-existing type 1 diabetes mellitus, and type 2 diabetes mellitus. Our study suggests that children exposed to diabetes during prenatal development are at a higher risk of developing ADHD. These findings underscore the critical importance of early screening and timely interventions for exposed offspring.

Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta-analysis.

Intrauterine devices (IUDs) are highly effective contraceptives. Despite their effectiveness, pregnancies can occur during IUD use, and the management of such cases, particularly when the pregnancy is desired, remains controversial. We conducted a systematic review and meta-analysis to evaluate outcomes in women who unintentionally conceived while using IUDs and chose to continue their pregnancies. We searched PubMed, Embase, and Cochrane databases to identify studies comparing women who removed their IUD after pregnancy discovery to those who retained it. The primary outcomes assessed were miscarriage, bleeding during pregnancy, and preterm delivery. Secondary outcomes included cesarean delivery, chorioamnionitis, congenital malformations, intrauterine growth restriction, preterm premature rupture of membranes, and stillbirth. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the binary outcomes using random-effects models to account for variability across studies. The certainty of evidence was measured using the Grading of Recommendations Assessment, Development, and Evaluation approach. From 3719 records, 4 cohorts were included. Among the 693 pregnant women analyzed, 402 had their IUD removed, while 291 retained the device. The analysis focused on copper IUDs, with most studies reporting removal during the first trimester and after ultrasound evaluation, although gaps in standardized reporting practices and removal methods were noted. Significant benefits were observed for the IUD-removed group, including reduced incidences of bleeding during gestation (OR 0.42; 95% CI 0.24 to 0.73; p < 0.01. Moderate certainty of evidence), and miscarriage (OR 0.29; 95% CI 0.17 to 0.48; p < 0.01. Moderate certainty of evidence). There was no significant difference in preterm delivery rates (OR 0.78; 95% CI 0.34 to 1.76; p = 0.55). This meta-analysis, based on data from cohort studies with moderate certainty of evidence, indicates that removing an IUD after pregnancy diagnosis may reduce the odds of miscarriage and bleeding during gestation. However, further high-quality research is needed to evaluate outcomes in pregnancies associated with hormonal IUDs, as well as critical factors such as gestational age at diagnosis, timing of IUD removal, and the position of the gestational sac relative to the device.

Systematic Review and Meta-analysis of the Effectiveness of Whole-school Interventions Promoting Mental Health and Preventing Risk Behaviours in Adolescence.

Adolescence is a vulnerable period for the onset of mental disorders and risk behaviours. Based on the Health-Promoting Schools Framework, whole-school interventions offer a promising strategy in this developmentally-sensitive cohort, through championing a systems-based approach to promotion and prevention that involves the key stakeholders in an adolescent's life. The evidence-base surrounding the effectiveness of whole-school interventions, however, remains inconclusive, partly due to the insufficient number of studies in previous meta-analyses. An updated systematic review and meta-analysis was thus conducted on the effectiveness of whole-school interventions promoting mental health and preventing risk behaviours in adolescence. From 12,897 search results, 28 studies reported in 58 publications were included. Study characteristics and implementation assessments were synthesized across studies, and quality appraisals and meta-analyses performed. Analyses identified a significant reduction in the odds of cyber-bullying by 25%, regular smoking by 31% and cyber-aggression by 37% in intervention participants compared to the control. Whole-school interventions thus offer substantial population health benefits through the reduction of these highly-prevalent issues affecting adolescents. The non-significant findings pertaining to the remaining eleven outcomes, including alcohol use, recreational drug use, anxiety, depression and positive mental health, are likely attributable to suboptimal translation of the Health-Promoting Schools Framework into practice and inadequate sensitivity to adolescents' local developmental needs. Given the ongoing challenges faced in the implementation and evaluation of these complex interventions, this study recommends that future evaluations assess the implementation of health-promoting activities in both intervention and control conditions and actively use this implementation data in the interpretation of evaluation findings.Preregistration: A pre-registered PROSPERO protocol (ID: CRD42023491619) informed this study.

Supplemental Material for Therapist Affect Focus and Patient Outcomes in Psychodynamic Therapy: An Updated Systematic Review and Meta-Analysis

Supplemental Material for Therapist Affect Focus and Patient Outcomes in Psychodynamic Therapy: An Updated Systematic Review and Meta-Analysis

Financial incentives for physical activity in adults: Systematic review and meta-analysis update.

To update the evidence on the effects of financial incentives (FI) on physical activity (PA) in adults. A systematic search of nine databases (Medline, EMBASE, PsychINFO, Scopus, Web of Science, CINAHL, EconLit, SPORTDiscus, and Cochrane) was conducted to identify randomised controlled trials (RCTs) and pilot RCTs published between June 1, 2018 and March 31, 2024 examining FI-for-PA interventions. 'Vote counting' and random-effects meta-analyses assessed short- (<6 months) and long-term (≥6 months) FI effects, as well as impact during follow-up (incentive withdrawal). Meta-regressions examined moderator effects. Twenty-nine studies (n = 21 RCT, n = 8 pilot RCTs; median FI size = $1.19 USD/day) involving 9604 participants were included (60.8 % female, mean age = 42.7 years). 17 of 21 studies reported positive short-term effects. 5 of 5 and 3 of 8 studies, respectively, reported positive long-term and follow-up effects. Among the 15 studies included in daily step count meta-analyses (most commonly reported PA outcome), FI had a moderate effect during short-term interventions (standardized mean difference [SMD] [95 % CI] = 0.52 [0.25-0.78], p < 0.001) and a small effect in follow-up (SMD [95 % CI] = 0.20 [0.01-0.40], p = 0.04). Too few long-term studies reported daily step count to conduct pooled analyses (n = 1). Meta-regressions suggest study length, incentive size, wearable device-use, and goal setting moderate FI effects (p < 0.05). Twenty-nine studies were identified over a 6-year span. Short-term FI interventions increase PA. The impact on daily step count is clinically significant (≥1000 steps/day). Key contextual factors moderate effects. Evidence is limited regarding long-term and follow-up effects.

Conducting Pairwise and Network Meta-analyses in Updated and Living Systematic Reviews: a Scoping Review Protocol.

The objective of this scoping review will be to describe existing guidance documents or studies reporting on the conduct of meta-analyses in updated systematic reviews (USRs) or living systematic reviews (LSRs). The rapid increase in the medical literature poses a substantial challenge in keeping systematic reviews up to date. In LSRs, a review is updated with a pre-specified frequency or when some other signalling criterion is triggered. While the LSR framework is well-established, there is uncertainty regarding the most appropriate methods for conducting repeated meta-analyses over time, which may result in sub-optimal decision-making. Studies of any design (including commentaries, books, manuals) providing guidance on conducting meta-analysis in USRs or LSRs. We will use the JBI methodology for scoping reviews. We will search multiple medical bibliographic databases (Cochrane Library, Embase, ERIC, MEDLINE, JBI Evidence Synthesis, and PsycINFO), statistical and mathematics databases (COBRA, Current Index to Statistics, MathSciNet, Project Euclid Complete, and zbMATH), pre-print archives (Arvix, BioRxiv, and MedRxiv), as well as difficult to locate/unpublished (or gray) literature. Two reviewers will independently screen titles, abstracts, and full-text documents, and extract data. Characteristics of recommendations for meta-analysis in USRs and LSRs will be presented using descriptive statistics and categorized concepts.Details of this review project can be found in Open Science Framework: https://osf.io/9c27g.

Nurse-Led Electrical External Cardioversion of Patients with Atrial Arrhythmia: A Systematic Review Update and Meta-Analysis

Nurse-Led Electrical External Cardioversion of Patients with Atrial Arrhythmia: A Systematic Review Update and Meta-Analysis

Quality appraisal of household recycling influences research found evidence was mostly insufficient for drawing conclusions.

Research on recycling behaviour and its influences is critical to supporting public policy efforts to mitigate the negative effects of waste. However, recent reviews have raised concerns about the quality of recycling research. Despite this, no previous reviews have conducted quality appraisals. This is partly because validated appraisal tools have typically been developed for intervention reviews in the health/medicine fields, creating difficulties applying to behaviour influence reviews in environmental fields. This update of a previous systematic review aims to fill this gap. We developed and piloted a novel quality appraisal framework tailored to interdisciplinary reviews of influences on recycling behaviours. Application of the novel framework to 118 recycling papers highlighted a lack of strongly-rated evidence, particularly for causal claims and operationalisation of behaviour. Specifically, over 80% of papers contained insufficient causal evidence, while 90% contained insufficient or cautious evidence of influence on actual behaviour. Only four papers (1%) produced strong evidence across both measures, allowing compelling confidence in their conclusions. Lack of quality evidence undermines the ability of remaining papers (and the body of literature as a whole) to draw strong conclusions about what factors have causal influence on actual recycling behaviour. This has implications for how well the field can guide interventions to improve recycling outcomes. To strengthen future research, this review identifies feasible instances of better practice to increase quality of evidence. Implementing such recommendations could increase the field's confidence in what influences household recycling. The quality appraisal framework may also be of interest for other pro-environmental behaviours.

Early vs. Late Inguinal Hernia Repair in Preterm Infants: An Updated Systematic Review and Meta-Analysis with Trial Sequential Analysis

Early vs. Late Inguinal Hernia Repair in Preterm Infants: An Updated Systematic Review and Meta-Analysis with Trial Sequential Analysis

Intracardiac or transesophageal echocardiography for left atrial appendage occlusion: an updated systematic review and meta-analysis.

Intracardiac echocardiography (ICE) appears to be a potential alternative for percutaneous left atrial appendage occlusion (LAAO) to transesophageal echocardiography (TEE). Thus, a meta-analysis was performed comparing ICE vs. TEE for LAAO guidance. A comprehensive literature search was performed using MEDLINE, Scopus and Web of Science electronic databases from their inception to November 2023. 18 studies (124,230 patients) were included. Technical success was higher in ICE- compared to TEE-guidance (OR: 1.36, 95% CI 1.14 to 1.63, p = 0.006) and fewer devices employed (SMD: -0.22, 95% CI -0.43 to -0.01, p = 0.04, I2 = 62%). ICE guidance related with more pericardial effusion/tamponade and iatrogenic residual shunts (logRR: 0.62, 95% CI 0.36 to 0.89, p < 0.001 and RR: 1.53, 95% CI 1.12 to 2.09, p = 0.02, I2 = 1%, respectively). More vascular complications were noted in ICE group (logRR: 0.45, 95% CI 0.11 to 0.78, p = 0.009). ICE-guided imaging is an effective alternative to TEE in LAAO, as it shows better efficacy than TEE, considering technical success. However, the higher rates of adverse events should be carefully considered.