1,721,056 research outputs found
Models and scores to predict adequacy of bowel preparation before colonoscopy
No full text: Adequate bowel preparation is of paramount importance for the effectiveness of preventive colonoscopy as it allows visualization of the mucosal surface and adenomas detection, the pre-malignant lesions leading to colon cancer. Still, a considerable portion of patients fail to achieve adequate bowel cleansing, with predictors of inadequate bowel preparation being at the focal point of several studies, so far. Incorporation of these factors within predictive models has been implemented in an effort to promptly identify patients at risk for inadequate bowel preparation and thus, timely adopt practices that have the potential to improve bowel cleansing. Ultimately, this could lead to improved procedural outcomes not only in terms of neoplastic detection rate but also interval repeat procedures, expenses, patient convenience and adverse events risk. Aim of this manuscript is to present an up to date overview of all predictive scores/models addressing bowel cleansing adequacy in everyday clinical practice
Effect of add-on devices with projections on screening colonoscopy: a systematic review and meta-analysis
No full textBackground Add-on devices with projections, e.g., Endocuff, Endocuff Vision, EndoRings, and Wingcap, placed on the distal tip of the colonoscope promise to improve the detection of precancerous lesions. We performed a meta-analysis to evaluate the performance of these devices exclusively among individuals undergoing colonoscopy for screening purpose. Methods A computerized literature search was performed across MEDLINE and Cochrane Library databases for randomized controlled trials that compared standard colonoscopy (SC) to procedures using add-on devices. The primary outcome was adenoma detection rate (ADR), while secondary outcomes included polyp detection rate (PDR), advanced ADR (AADR), and sessile serrated lesion detection rate (SSLDR). The effect size on study outcomes was calculated using a random-effects model and presented as the risk ratio (RR) and 95% confidence interval (CI). Results Seven studies enrolling a total of 5785 patients were included. The use of add-on-devices with projections was associated with a higher ADR compared to SC: 45.9% vs. 41.1%; RR 1.18, 95%CI 1.02-1.37; P=0.03; & UIota;2=79%. Although PDR was higher in screening colonoscopies assisted by add-on devices as compared to SC, the difference failed to reach significance: 55.1% vs. 50.8%; RR 1.10, 95%CI 0.96-1.26; P=0.17; & UIota;2=75%. No difference was found between procedures assisted by add-on devices with projections and SC colonoscopies in terms of AADR (18.5% vs. 17.6%; RR 1.00, 95%CI 0.79-1.27; P=0.98; & UIota;2=56%) or SSLDR (6.8% vs. 5.8%; RR 1.17, 95%CI 0.95-1.44; P=0.15; I2=0%). Conclusion Colonoscopy assisted by add-on devices with projections achieves a better ADR compared to SC among individuals undergoing screening for bowel cancer
The impact of center and endoscopist ERCP volume on ERCP outcomes: a systematic review and meta-analysis
No full textBackground and aims: Endoscopist experience and center volume might be associated with endoscopic retrograde cholangiopancreatography (ERCP) outcomes, as in other fields of endoscopy and in surgery. An effort to assess this relationship is important to improve practice. This systematic review and meta-analysis aimed to evaluate these comparative data and assess the impact of endoscopist and center volume on ERCP procedure outcomes. Methods: We performed a literature search in PubMed, Web of Science and Scopus through March 2022. Volume classification included high- and low-volume (HV and LV) endoscopists and centers. The primary outcome was the impact of endoscopist and center volume on ERCP success. Secondary outcomes included the overall AEs rate, and the specific AEs rate. The quality of the studies was assessed using the Newcastle-Ottawa scale. Data synthesis was obtained by direct meta-analyses using a random-effects model; the results were presented as odds ratios (OR) with 95% confidence intervals (CI). Results: Of 6833 relevant publications, 31 studies met the inclusion criteria. Procedure success was higher among HV endoscopists ([OR=1.81(95%CI,1.59-2.06),I2=57%] and in HV centers [OR=1.77(95%CI,1.22-2.57),I2=67%]. The overall AEs rate was lower for procedures performed by HV endoscopists [OR=0.71(95%CI,0.61-0.82),I2=38%] and in HV centers [OR=0.70(95%CI,0.51-0.97),I2=92%]. Bleeding was less frequent in procedures performed by HV endoscopists [OR=0.67(95%CI,0.48-0.95),I2=37%], but did not differ based on center volume [OR=0.68(95% CI,0.24-1.90),I2=89%]. No statistical differences were detected concerning pancreatitis, cholangitis, and perforation rates. Conclusion: High-volume endoscopists and centers provide higher ERCP success rates with fewer overall adverse events, especially bleeding, compared to the respective low-volume comparators
Efficacy of different stent types in post-liver-transplant anastomotic biliary strictures: a systematic review and meta-analysis
No full textBackground Stent selection in the endoscopic management of post-liver-transplant anastomotic biliary strictures remains controversial. This systematic review and meta -analysis aimed to evaluate the potential differences between available stents. Methods MEDLINE, Cochrane, and Scopus databases were searched until April 2023 for comparative studies evaluating stricture management using multiple plastic stents (MPS) and self-expandable metal stents (SEMS), including fully-covered (FC)- and intraductal (ID)-SEMS. The primary outcome was stricture resolution, while secondary outcomes included stricture recurrence, stent migration and adverse events. Meta-analyses were based on a random-effects model and the results were reported as odds ratios (OR) with 95% confidence intervals (CI). Subgroup analyses by type of metal stent and a cost-effectiveness analysis were also performed. Results Nine studies (687 patients) were finally included. Considering stricture resolution, SEMS and MPS did not differ significantly (OR 0.99, 95%CI 0.48-2.01; I 2 =35%). Stricture recurrence, migration rates and adverse events were also comparable (OR 1.71, 95%CI 0.87-3.38; I 2 =55%, OR 0.73, 95%CI 0.32-1.68; I 2 =56%, and OR 1.47, 95%CI 0.89-2.43; I 2 =24%, respectively). In the subgroup analysis, stricture resolution and recurrence rates did not differ for ID-SEMS vs. MPS or FC-SEMS vs. MPS. Migration rates were lower for ID-SEMS compared to MPS (OR 0.28, 95%CI 0.11-0.70; I 2 =0%), and complication rates were higher after FC-SEMS compared to MPS (OR 1.76, 95%CI 1.06-2.93; I 2 =0%). Finally, ID-SEMS were the most cost-effective approach, with the lowest incremental cost-effectiveness ratio: 3447.6 pound/QALY. Conclusion Stent type did not affect stricture resolution and recurrence; however, ID-SEMS placement was the most cost-effective approach compared to the alternatives
Endoscopic retrograde cholangiopancreatography: A comprehensive review as a single diagnostic tool
No full textEndoscopic retrograde cholangiopancreatography (ERCP) was initially introduced in clinical practice as diagnostic tool. However, the presence of adverse events and the development of non-invasive techniques, such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS), limited its role as a stand-alone diagnostic choice, modifying its role to the leader of therapeutic pancreatobiliary endoscopy. Despite technological advances, there are still conditions where non-invasive diagnostic modalities are inconclusive,
such as indeterminate biliary and pancreatic duct strictures, primary sclerosing cholangitis functional stenoses, intraductal papillary mucinous neoplasms (IPMNs) and paediatric indications, such as congenital anatomical abnormalities. This narrative review aimed to identify and analyse indications of diagnostic ERCP, without the need for therapeutic manipulations
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The role of small intestinal bacterial overgrowth syndrome in patients with non alcoholic fatty liver disease
No full textBackground: 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
Ο ρόλος του συνδρόμου βακτηριακής υπερανάπτυξης του λεπτού εντέρου σε ασθενείς με μη αλκοολική λιπώδη νόσο του ήπατος
No full textΕισαγωγή: 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). 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.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
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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