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RISS 인기검색어
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- 저자 : Eduardo Guimarães Hourneaux De Moura (검색결과 2 건)
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Role of Cardiac Septal Occluders in the Treatment of Gastrointestinal Fistulas: A Systematic Review
Diogo Turiani Hourneaux De Moura,Alberto Baptista,Pichamol Jirapinyo,Eduardo Guimarães Hourneaux De Moura,Christopher Thompson 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.1
Treating gastrointestinal (GI) fistulas endoscopically is challenging owing to an established epithelial tract. The variety of endoscopicapproaches is transforming endoscopy into a first-line therapy. However, many sessions are often required, with variable success rates. Owing to these limitations, the off-label use of cardiac septal occluders (CSOs) has been reported. We searched for articles related to CSOs in the MEDLINE, EMBASE, Cochrane Library, and LILACS databases and gray literature. Theprimary outcomes included technical success, clinical success, and safety of CSOs in GI fistula management. A total of 25,574 records were identified, and 19 studies ultimately satisfied the inclusion criteria. Technical success was achieved inall cases. Of the 22 fistulas, 77.27% had successful closure, with a mean follow-up period of 32.02 weeks. The adverse event rate was22.72%, with no associated mortality. Univariable and multivariable regression analyses showed no significant difference in the successof closure and adverse events in relation to several variables among the subgroups. The use of CSOs appeared to be technically feasible, effective, and safe in the treatment of GI fistulas. The satisfactory results derived fromthis sparse literature suggest that it can be an option in the management of GI fistulas.
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Diogo Turiani Hourneax de Moura,Marvin Ryou,Eduardo Guimarães Hourneaux De Moura,Igor Braga Ribeiro,Wanderlei Marques Bernardo,Christopher C. Thompson 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.4
Background/Aims: The diagnosis of biliary strictures can be challenging. There are no systematic reviews studying same-sessionendoscopic retrograde cholangiopancreatography (ERCP)-based tissue sampling and endoscopic ultrasound-guided fine needleaspiration (EUS-FNA) for the diagnosis of biliary strictures. Methods: A systematic review was conducted on studies analyzing same-session EUS and ERCP for tissue diagnosis of suspectedmalignant biliary strictures. The primary outcome was the accuracy of each method individually compared to the two methodscombined. The secondary outcome was the accuracy of each method in pancreatic and biliary etiologies. In the meta-analysis, we usedForest plots, summary receiver operating characteristic curves, and estimates of the area under the curve for intention-to-treat analysis. Results: Of the 12,132 articles identified, six were included, resulting in a total of 497 patients analyzed. The sensitivity, specificity,positive likelihood ratio, negative likelihood ratio, and accuracy of the association between the two methods were: 86%, 98%, 12.50,0.17, and 96.5%, respectively. For the individual analysis, the sensitivity, specificity and accuracy of EUS-FNA were 76%, 100%, and94.5%, respectively; for ERCP-based tissue sampling, the sensitivity, specificity, and accuracy were 58%, 98%, and 78.1%, respectively. For pancreatic lesions, EUS-FNA was superior to ERCP-based tissue sampling. However, for biliary lesions, both methods had similarsensitivities. Conclusions: Same-session EUS-FNA and ERCP-based tissue sampling is superior to either method alone in the diagnosis of suspectedmalignant biliary strictures. Considering these results, combination sampling should be performed when possible.
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