1,721,061 research outputs found
재발성 양성 유두부 종양의 추적 관찰 및 치료
No full textThe widespread use of screening endoscopy has increased the detection rate of ampullary neoplasms. Most of these lesions are adenomas or carcinomas. The recurrence rates after an endoscopic papillectomy have been reported to range from 5% to 40%, even in cases with pathologically confirmed complete resection. An endoscopic mucosal resection (EMR) is commonly performed for residual or recurrent lesions, and endoscopic ablation therapies, such as argon plasma coagulation, may be used either as an alternative to or in conjunction with EMR. Recently, radiofrequency ablation (RFA) has garnered attention as a potential alternative to surgical treatment for intraductal residual or recurrent ampullary neoplasms after an endoscopic papillectomy, showing a 75.7% clinical success rate. In cases of recurrence after initial RFA, additional RFA has enabled oncologic control in nearly all patients without the need for surgery. Nevertheless, further prospective studies and accumulation of evidence are necessary to establish the efficacy and safety of RFA in this setting
A Stone in Remnant Cystic Duct Causing Mirizzi Syndrome Following Laparoscopic Cholecystectomy
Full text linkComparison of clinical outcomes for single- and double-balloon enteroscope-assisted endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy
No full textBACKGROUND: Balloon-assisted enteroscopy with a specialized overtube has improved the success of endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA). However, direct comparative data between double-balloon enteroscopy (DBE) and single-balloon enteroscopy (SBE) remain limited. AIM: To compare the ERCP-related outcomes between DBE and SBE in patients with SAA. METHODS: We retrospectively reviewed the medical records of 1042 patients with SAA who underwent ERCP. After propensity score matching for age and sex, 494 patients were included, with 247 patients in each of the SBE and DBE groups. RESULTS: The success rates of intubation, cannulation, completion of intended ERCP, and adverse events were similar between the DBE and SBE groups (94.3% vs 96.4%, P = 0.393; 89.5% vs 93.5%, P = 0.147; 88.3% vs 92.7%, P = 0.125; 10.5% vs 14.6%, P = 0.222, respectively). However, the SBE group had significantly longer intubation and procedure times than the DBE group (23.5 +/- 22.3 minutes vs 14.1 +/- 13.5 minutes, P < 0.001; 65.2 +/- 37.9 minutes vs 31.0 +/- 18.5 minutes, P < 0.001). Preserved gastric anatomy and Roux-en-Y reconstruction were independently associated with intubation failure (odds ratio = 3.18, 95% confidence interval: 1.30-8.31; odds ratio = 8.65, 95% confidence interval: 1.71-157.60, respectively). CONCLUSION: DBE and SBE showed comparable clinical success and safety profiles in ERCP for patients with SAA, although SBE required significantly longer procedure times. DBE could provide procedural efficiency benefits in cases where an extended procedure duration is expected. Furthermore, a preserved gastric anatomy and Roux-en-Y reconstruction were identified as independent risk factors for intubation failure
Pre- and post-procedure risk prediction models for post-endoscopic retrograde cholangiopancreatography pancreatitis
No full textBACKGROUND: Post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) is the most common serious adverse event. Given recent endoscopic advances, we aimed to develop and validate a risk prediction model for PEP using the latest clinical database. METHODS: We analyzed the data of patients with naive papilla who underwent endoscopic retrograde cholangiopancreatography (ERCP). Pre-ERCP and post-ERCP risk prediction models for PEP were developed using logistic regression analysis. Patients were classified into low- (0 points), intermediate- (1-2 points), and high-risk (>/= 3 points) groups according to point scores. RESULTS: We included 760 and 735 patients in the derivation and validation cohorts, respectively. The incidence of PEP was 5.5% in the derivation cohort and 3.9% in the validation cohort. Age /= 3 points) had a significantly higher risk of PEP compared to the low- or intermediate-risk groups under the post-ERCP risk prediction model (low: 2.0%; intermediate: 3.4%; high: 18.4%), while there was no significant between-group difference under the pre-ERCP risk prediction model (low: 2.2%; intermediate: 3.8%; high: 6.9%). CONCLUSIONS: We developed and validated pre-ERCP and post-ERCP risk prediction models. In the latter, the high-risk group had a higher risk of PEP development than the low- or intermediate-risk groups. Our study findings will help clinicians stratify patient risk for the development of PEP
Conversion of percutaneous transhepatic biliary drainage to endoscopic ultrasonography‐guided hepaticogastrostomy under balloon‐targeted selective needle puncture
No full textRecent advances of endoscopic retrograde cholangiopancreatography in surgically altered anatomy
Full text linkEndoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) of the upper gastrointestinal tract is a more technically challenging and arduous procedure accompanied by a low success rate of reaching the target orifice and a relatively high rate of complications, compared to those with normal anatomy. Since the introduction of device-assisted enteroscopies such as balloon enteroscopy (BE) and manual spiral enteroscopy (SE) for small bowel disorders, they have also been used for ERCP in patients with SAA. The recent development of short-type BE makes ERCP in patients with SAA technically easier with high success rates and short procedural duration, and then short-type BE is considered the gold standard endoscopic procedure in these patients. Laparoscopy-assisted ERCP is another therapeutic option, especially for patients with a long excluded afferent limb of SAA. The choice of procedure for high success rates should be individualized according to patient characteristics and available physician competence. Moreover, novel motorized SE is a promising alternative procedure for the successful performance of ERCP
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
Endoscopic ultrasound-rendezvous versus percutaneous-endoscopic rendezvous endoscopic retrograde cholangiopancreatography for bile duct access: Systematic review and meta-analysis
No full textObjectives: Endoscopic ultrasound (EUS) or percutaneous-assisted antegrade guidewire insertion can be used to achieve biliary access when standard endoscopic retrograde cholangiopancreatography (ERCP) fails. We conducted a systematic review and meta-analysis to evaluate and compare the effectiveness and safety of EUS-assisted rendezvous (EUS-RV) and percutaneous rendezvous (PERC-RV) ERCP. Methods: We searched multiple databases from inception to September 2022 to identify studies reporting on EUS-RV and PERC-RV in failed ERCP. A random-effects model was used to summarize the pooled rates of technical success and adverse events with 95% confidence interval (CI). Results: In total, 524 patients (19 studies) and 591 patients (12 studies) were managed by EUS-RV and PERC-RV, respectively. The pooled technical successes were 88.7% (95% CI 84.6–92.8%, I2 = 70.5%) for EUS-RV and 94.1% (95% CI 91.1–97.1%, I2 = 59.2%) for PERC-RV (P = 0.088). The technical success rates of EUS-RV and PERC-RV were comparable in subgroups of benign diseases (89.2% vs. 95.8%, P = 0.068), malignant diseases (90.3% vs. 95.5%, P = 0.193), and normal anatomy (90.7% vs. 95.9%, P = 0.240). However, patients with surgically altered anatomy had poorer technical success after EUS-RV than after PERC-RV (58.7% vs. 93.1%, P = 0.036). The pooled rates of overall adverse events were 9.8% for EUS-RV and 13.4% for PERC-RV (P = 0.686). Conclusions: Both EUS-RV and PERC-RV have exhibited high technical success rates. When standard ERCP fails, EUS-RV and PERC-RV are comparably effective rescue techniques if adequate expertise and facilities are feasible. However, in patients with surgically altered anatomy, PERC-RV might be the preferred choice over EUS-RV because of its higher technical success rate
Diagnosis of invasive pancreatic cancer in endoscopic ultrasound images leveraging translation models
No full textBackground: In guiding treatment decisions for pancreatic cancer, assessing vascular invasion is critical, particularly for determining resectability. Deep learning techniques have demonstrated potential for diagnosing vascular invasion through the analysis of pancreatic endoscopic ultrasound (EUS) images. However, challenges arise when dealing with multicenter data sources and imbalanced datasets, which may affect the performance of deep learning models. Method: EUS images were collected from 170 patients with pancreatic cancer diagnosed at three endoscopy centers using various ultrasound systems. To diagnose vascular invasion while mitigating data variations, feature and image translation models were utilized to effectively align the source and target domains. An image translation model was utilized in the proposed approach (multicenter transfer learning (MCTL)) by employing CycleGAN and customized weighted loss classification models. The performance was compared with those of a feature translation model (multicenter domain adaptation (MCDA)) and widely accepted baseline classification models. Result: The translation models compensated for the distinctive data-specific features and improved the models for classifying vascular invasion. Although the feature translation model proved effective, its applicability was limited across different datasets. The proposed MCTL approach showed superior classification performance with accuracy improvements of 26.79%, 67.26%, and 50.91% over the baseline model and 17.86%, 48.81%, and 42.50% over the MCDA model for the three imbalanced datasets. Significance: This study leveraged a deep learning approach for enhancing the diagnosis of vascular invasion in pancreatic cancer using EUS images from multiple centers and addressed the issue of data imbalance
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