GI Surgery – Endoscopy
RCT: Cold Snare EMR Reduces Major Adverse Events but Increases Residual Adenoma in Large Nonpedunculated Colorectal Polyps – Gastroenterology
25 Aug, 2024 | 11:45h | UTCStudy Design and Population: This multicentric randomized controlled trial (RCT) involved 19 centers in Germany and included 363 patients with 396 large nonpedunculated colorectal polyps (≥20 mm). Participants were randomly assigned to undergo either cold snare endoscopic mucosal resection (EMR) or the traditional hot snare EMR. The study aimed to compare the safety and effectiveness of cold versus hot snare EMR.
Main Findings: Cold snare EMR significantly reduced the incidence of major adverse events (AEs), with a major AE rate of 1.0% compared to 7.9% in the hot snare group. This included significant reductions in perforation and postendoscopic bleeding rates. However, cold snare EMR was associated with a higher rate of residual adenoma at follow-up, with 23.7% of cases compared to 13.8% in the hot snare group. The increased rate of residual adenoma was particularly noted in larger lesions (≥4 cm) and those with high-grade dysplasia.
Implications for Practice: Cold snare EMR offers a safer alternative to hot snare EMR for resecting large nonpedunculated colorectal polyps, particularly in terms of reducing major AEs. However, the higher rate of residual adenoma indicates that cold snare EMR should be used selectively, especially for smaller polyps or less likely to have advanced histology. Further research is needed to refine lesion selection criteria and to explore technical modifications that could improve the efficacy of cold snare EMR.
Randomized Noninferiority Trial: Oral Vonoprazan Noninferior to IV Proton Pump Inhibitors in Preventing Rebleeding of High-Risk Peptic Ulcers – Gastroenterology
18 Aug, 2024 | 18:32h | UTCStudy Design and Population: This multicenter, randomized, open-label, noninferiority trial was conducted in Thailand across six centers, including both university and community hospitals. A total of 194 patients with high-risk peptic ulcer (PU) bleeding who had achieved successful endoscopic hemostasis were randomized to receive either vonoprazan or intravenous proton pump inhibitors (PPI). The study aimed to compare the efficacy of vonoprazan, a potassium-competitive acid blocker, with that of high-dose PPIs in preventing rebleeding.
Main Findings: The trial found that the 30-day rebleeding rate in the vonoprazan group was 7.1%, compared to 10.4% in the PPI group. This demonstrated noninferiority of vonoprazan within a 10% margin (risk difference: -3.3%, 95% CI: -11.2 to 4.7; P < .001). The 3-day and 7-day rebleeding rates were also noninferior. Secondary outcomes, including mortality rates, the need for rescue therapy, blood transfusion requirements, and length of hospital stay, were comparable between the two groups. Adverse events were similar in both groups.
Implications for Practice: Vonoprazan presents a viable alternative to intravenous PPIs for preventing rebleeding in patients with high-risk PU after endoscopic hemostasis. The availability of vonoprazan in oral form could potentially reduce hospital stays. However, further studies in multiethnic populations are needed to confirm these findings and assess the cost-effectiveness of vonoprazan in this setting.
Cohort Study: Extending colonoscopy intervals to 15 years seems feasible in after a negative initial test in individuals without family history of CRC – JAMA Oncol
6 May, 2024 | 06:25h | UTCThis cohort study analyzed Swedish register-based data, examining colorectal cancer (CRC) diagnoses and CRC-specific mortality. The study included 110,074 individuals with a negative first colonoscopy (exposed group) and 1,981,332 matched controls, from 1990 to 2018. Participants were aged 45 to 69 at initial screening and were followed for up to 29 years.
During the follow-up, 484 new CRC cases and 112 CRC-specific deaths occurred in the exposed group. The study found significantly lower risks of CRC and CRC-specific death in the exposed group compared to controls over 15 years. The data suggest extending the screening interval from 10 to 15 years could miss only 2 CRC cases and prevent 1 CRC-specific death per 1,000 individuals while potentially reducing unnecessary colonoscopies.
The findings suggest that for individuals with no family history of CRC and a negative initial screening, the standard 10-year colonoscopy interval could safely be extended to 15 years. This adjustment could decrease the number of invasive procedures without significantly impacting cancer incidence and mortality, optimizing resource allocation and reducing patient burden.
Reference (link to abstract – $ for full-text):
ACP Guidance | Asymptomatic CRC screening advised from age 50 with fecal occult blood test every 2 years or colonoscopy every 10 years
3 Aug, 2023 | 13:48h | UTCNews Release: ACP issues updated guidance for colorectal cancer screening of asymptomatic adults – American College of Physicians
Commentary: Start screening for colorectal cancer at age 50 years, ACP suggests – ACP Internist
Summary for Patients: Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults – Annals of Internal Medicine
AASLD Guidance | Use of TIPS, variceal embolization, and retrograde transvenous obliteration in variceal hemorrhage
11 Jul, 2023 | 13:59h | UTC
Position statement | Gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy
21 Jun, 2023 | 13:22h | UTCPosition statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy – Indian Journal of Gastroenterology (if the link is paywalled, try this one)
RCT | Hemostatic powder provides better control of gastrointestinal tumor bleeding than standard endoscopic treatment
20 Jun, 2023 | 12:39h | UTCHemostatic powder vs. standard endoscopic treatment for gastrointestinal tumor bleeding: A multicenter randomized trial – Gastroenterology (link to abstract – $ for full-text)
Position Statement | Curriculum for training in endoscopic mucosal resection in the colon
19 Jun, 2023 | 13:42h | UTC
SR | Systematic review finds 16.4-36.18 severe bleedings, 7.62-8.5 perforations per 10,000 colonoscopies
1 Jun, 2023 | 12:15h | UTC
RCT | Per-oral endoscopic myotomy outperforms pneumatic dilation for post-laparoscopic heller myotomy achalasia
16 May, 2023 | 14:36h | UTC
Guideline | Perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography
4 May, 2023 | 13:52h | UTC
Review | Lynch syndrome genetics and clinical implications
4 May, 2023 | 13:24h | UTCLynch syndrome genetics and clinical implications – Gastroenterology
Cohort Study | Cancer surveillance as an alternative to prophylactic total gastrectomy in hereditary diffuse gastric cancer
17 Apr, 2023 | 12:57h | UTCCancer surveillance as an alternative to prophylactic total gastrectomy in hereditary diffuse gastric cancer: a prospective cohort study – The Lancet Oncology (link to abstract – $ for full-text)
Commentary: Endoscopic Surveillance in Patients at Risk for Hereditary Diffuse Gastric Cancer – The ASCO Post
Screening colonoscopy in seniors: common in patients with limited life expectancy and associated with higher complication risks
11 Apr, 2023 | 14:30h | UTCFrequency of Use and Outcomes of Colonoscopy in Individuals Older Than 75 Years – JAMA Internal Medicine (link to abstract – $ for full-text)
Related: Study reveals overuse of surveillance colonoscopy in older adults with limited life expectancy
Commentary:
In older adults >75 years of age, most screening colonoscopies were in patients in patients with limited life expectancy (defined as <10 years) and associated with increased risk of adverse events. https://t.co/XOsy2UKNRx @Jessica_Halabi @MRothbergMD @burkegastrodoc
— JAMA Internal Medicine (@JAMAInternalMed) April 4, 2023
RCT | Over-the-scope clips show lower rebleeding rates in nonvariceal GI bleeding
6 Apr, 2023 | 12:57h | UTCComparison of Over-the-Scope Clips to Standard Endoscopic Treatment as the Initial Treatment in Patients With Bleeding From a Nonvariceal Upper Gastrointestinal Cause: A Randomized Controlled Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries:
Over-the-Scope Clip Beneficial for Nonvariceal Upper GI Bleeding – HealthDay
Commentary on Twitter
A new RCT found that over-the-scope-clips may be more effective than standard treatment for some patients with nonvariceal upper #GastrointestinalBleeding: https://t.co/GWG70CWmlt pic.twitter.com/Foq2qQZTEc
— Annals of Int Med (@AnnalsofIM) March 7, 2023
Study reveals overuse of surveillance colonoscopy in older adults with limited life expectancy
23 Mar, 2023 | 13:11h | UTCSummary: This study investigated the association between estimated life expectancy, surveillance colonoscopy findings, and follow-up recommendations among older adults. The study utilized data from the New Hampshire Colonoscopy Registry and included adults over 65 who underwent colonoscopy for surveillance after prior polyps.
Life expectancy was estimated using a validated prediction model and categorized into three groups: less than 5 years, 5 to less than 10 years, and 10 or more years.
Out of the 9,831 adults included in the study, 8% had advanced polyps or CRC. Among the 5,281 patients with available recommendations, 86.9% were advised to return for a future colonoscopy. Surprisingly, 58.1% of older adults with less than 5 years of life expectancy were also recommended to return for future surveillance colonoscopy.
The study concluded that many older adults with limited life expectancy are still recommended for future surveillance colonoscopy. This data could help refine decision-making about pursuing or stopping surveillance colonoscopy in older adults with a history of polyps.
Article: Association of Life Expectancy With Surveillance Colonoscopy Findings and Follow-up Recommendations in Older Adults – JAMA Internal Medicine (link to abstract – $ for full-text)
JAMA Patient Page: What Should I Know About Stopping Routine Cancer Screening?
Commentary on Twitter
Findings suggest that recommending against future surveillance colonoscopy in older adults with low-risk colonoscopy findings and/or limited life expectancy should be considered more frequently than is currently practiced. https://t.co/7jKpYyuZON
— JAMA Internal Medicine (@JAMAInternalMed) March 13, 2023
Guidelines for post polypectomy colonoscopic surveillance
22 Mar, 2023 | 13:31h | UTCRelated:
USPSTF Statement: Start colorectal cancer screening at 45 years for most patients.
ACG Clinical Guidelines: Start colorectal cancer screening at 45
Review | Choosing the best endoscopic approach for post-bariatric surgical leaks and fistulas
20 Mar, 2023 | 13:23h | UTC
ESGE Position Statement | Curriculum for bariatric endoscopy and endoscopic treatment of the complications of bariatric surgery
17 Mar, 2023 | 13:06h | UTC
RCT | Study finds both one-food and six-food elimination diets are effective initial options for eosinophilic esophagitis
7 Mar, 2023 | 13:17h | UTCSummary:
The article describes a multicenter randomized trial that compared the effectiveness of a one-food elimination diet (1FED – eliminating animal milk) versus a six-food elimination diet (6FED – eliminating animal milk, wheat, egg, soy, fish and shellfish, and peanut and tree nuts) for treating eosinophilic esophagitis in adults.
The study found that both diets were equally effective at achieving histological remission, although the 6FED resulted in a higher proportion of patients achieving complete remission. Patients who did not achieve histological remission with the 1FED could proceed to the 6FED, and 43% had histological remission. For those without response to the 6FED, topical fluticasone propionate induced remission in 82%.
Overall, the study suggests that eliminating animal milk alone is an acceptable initial dietary therapy for eosinophilic esophagitis.
Article: One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial – The Lancet Gastroenterology & Hepatology (link to abstract – $ for full-text)
News Release: Forgoing one food treats eosinophilic esophagitis as well as excluding six – National Institutes of Health
Related: M-A | Efficacy of elimination diets in eosinophilic esophagitis
Commentary on Twitter
New research – Kliewer et al – One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial https://t.co/Tpm0EPPfx0#EoE #GItwitter #RareDiseaseDay #CEGIR pic.twitter.com/iUcqIt9Pg5
— The Lancet Gastroenterology & Hepatology (@LancetGastroHep) February 28, 2023
SR | Erythromycin prior to endoscopy for acute upper gastrointestinal hemorrhage
3 Mar, 2023 | 13:33h | UTCErythromycin prior to endoscopy for acute upper gastrointestinal haemorrhage – Cochrane Library
Review | Platelet aggregation inhibitors and anticoagulants in gastroenterological and visceral surgical procedures
1 Mar, 2023 | 14:03h | UTC
Definition of age-dependent reference values for the diameter of the common bile duct and pancreatic duct on MRCP
1 Mar, 2023 | 13:56h | UTC
Commentary on Twitter
Setting the standards ? of common bile duct and pancreatic duct
? CBD up to 8 mm < 65 y/o and up to 11 mm in ≥65 y/o
? PD diameters up to 3 mm in <65 y/o and up to 4 mm in ≥65 y/o
Landmark open access @Gut_BMJ paper ? kudos to authors ! ?https://t.co/hGEkfeVeRc pic.twitter.com/E4IXU50EZi
— Giovanni Marchegiani (@Gio_Marchegiani) February 28, 2023
M-A | Efficacy of elimination diets in eosinophilic esophagitis
24 Feb, 2023 | 13:47h | UTCSummary: This systematic review and meta-analysis evaluated the effectiveness of various dietary treatment regimens for eosinophilic esophagitis (EoE). After analyzing 34 studies with 1762 patients, it was concluded that dietary therapy is a viable and efficacious option for individuals with EoE of all ages, with an overall histological remission rate of 53.8% and a clinical response rate of 80.8%. The study also found that highly restrictive dietary regimes, such as a six-food elimination diet, may not be superior to less restrictive dietary regimens, such as a four-food elimination diet or one-food elimination diet, in achieving histological remission, supporting less restrictive dietary regimens as a treatment option. The study has several limitations, such as the observational nature of most studies included.
Commentary: Elimination diets effective for patients with eosinophilic esophagitis – ACP Gastroenterology
Commentary on Twitter
Efficacy of dietary therapy in eosinophilic esophagitis for (1) histologic remission & (2) clinical response
6⃣-food elimination diet: 61%, 93%
4⃣-food elimination diet: 49%, 74%
1⃣-food elimination diet: 51%, 87%
Targeted elimination diet: 46%, 69%#EoEhttps://t.co/VKXgCQO9O6 pic.twitter.com/KfpSburuwN— John Damianos, M.D. (@john_damianosMD) February 1, 2023
Article under a Creative Commons Attribution (CC BY 4.0) license
Review | Management of gastrointestinal foreign bodies with brief review of the guidelines
24 Feb, 2023 | 13:36h | UTC