Background and Aim
Same‐visit colonoscopy and esophagogastroduodenoscopy (EGD) have become common. Recent studies showed conflicting results regarding the performance, safety, and efficacy of ...different sequences. We conducted this meta‐analysis to determine the most favorable performance and discomfort between an EGD followed by colonoscopy (E‐C) and colonoscopy followed by EGD (C‐E).
Methods
The authors searched the databases of MEDLINE and EMBASE. Outcomes of interest were performance (including cecal intubation time, adenoma detection rate, and polyp detection rate), discomfort score (patients and endoscopists; Likert scale), and sedation uses. Pooled mean differences (MD) or odds ratios (OR) were calculated with 95% confidence intervals (CI).
Results
Six randomized controlled trials were included in the meta‐analysis. The authors found that there was significantly lower sedative use including fentanyl (14.70; 95% Cl: 8.20–21.20) and propofol (15.58; 95% Cl: 3.27–27.89) in the E‐C group compared with the C‐E group. There was a significantly better discomfort score in patients and endoscopists after both procedures in the E‐C group than in the C‐E group with pooled MD of 0.64 points (95% Cl: 0.09–1.20) and 0.47 (95% Cl: 0.05–0.90), respectively. There were no differences in cecal intubation time, adenoma detection rate, or polyp detection rate between the two groups.
Conclusion
The present study found that the discomfort score was better in the E‐C group. However, there was no difference in polyp and adenoma detection. Therefore, the E‐C group is the optimal sequence.
Laparoscopic abdominal surgery has been widely used to reduce the length of hospital stay and complications from open abdominal surgery. During the operation, the creation of pneumoperitoneum is used ...for better visualization of the operating field. However, the effect of pneumoperitoneum on kidney function is unknown. We aimed to identify risk factors and predictors associated with AKI development following laparoscopic abdominal surgery.
A single-center prospective cohort study of laparoscopic abdominal surgery patients between June 2012 and December 2013. Acute kidney injury (AKI) was identified by Kidney Disease Improving Global Outcome (KDIGO) criteria. Urinary neutrophil gelatinase associated lipocalin (uNGAL) was measured on the first 3 days after surgery as a surrogate marker of AKI.
Of the 64 patients, 23 (35%) developed postoperative AKI. The mean age, initial blood pressure, and initial glomerular filtration rate were not different between AKI and non-AKI groups. Inflation time and exposure index were significantly higher in the AKI group compared to non-AKI group (192.0 vs 151.1 min, p = 0.045, and 2325.9 vs 1866.1 mmHg-minutes, p = 0.035). Operation time, mean intra-abdominal pressure, duration of intraoperative hypotension, amount of blood loss and intravenous fluid were not different between groups. In multivariable analysis adjusted for age, diabetes, baseline estimated glomerular filtration rate, and type of operation (urological surgery), exposure index was significantly associated with postoperative AKI, with odds ratio (95% CI) 1.47 (1.05-2.04), p = 0.024. By combining the intraoperative parameters with clinical model the area under the receiver operating characteristic curve was 0.71 (95% CI 0.58-0.84).
AKI was a common condition in laparoscopic abdominal surgery. Exposure index has been proposed as a novel predictor of laparoscopic abdominal surgery associated AKI.
Metastatic melanoma is generally rare, and the colon is a very rare metastatic site. We report a case of asymptomatic, isolated metastatic melanoma to the colon. Asymptomatic patients are usually not ...expected to have metastatic lesions in the colon. Ninety-five percent of large bowel metastases are identified during a postmortem examination. Our patient was found to have metastatic melanoma to the colon during a follow-up colonoscopy done for the surveillance of colon polyps. An awareness that patients with melanoma may possibly develop colon metastases is needed.
BACKGROUNDNon-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, affecting over 30% of the United States population. Early patient identification using a simple method is ...highly desirable. AIMTo create machine learning models for predicting NAFLD in the general United States population. METHODSUsing the NHANES 1988-1994. Thirty NAFLD-related factors were included. The dataset was divided into the training (70%) and testing (30%) datasets. Twenty-four machine learning algorithms were applied to the training dataset. The best-performing models and another interpretable model (i.e., coarse trees) were tested using the testing dataset. RESULTSThere were 3235 participants (n = 3235) that met the inclusion criteria. In the training phase, the ensemble of random undersampling (RUS) boosted trees had the highest F1 (0.53). In the testing phase, we compared selective machine learning models and NAFLD indices. Based on F1, the ensemble of RUS boosted trees remained the top performer (accuracy 71.1% and F1 0.56) followed by the fatty liver index (accuracy 68.8% and F1 0.52). A simple model (coarse trees) had an accuracy of 74.9% and an F1 of 0.33. CONCLUSIONNot every machine learning model is complex. Using a simpler model such as coarse trees, we can create an interpretable model for predicting NAFLD with only two predictors: fasting C-peptide and waist circumference. Although the simpler model does not have the best performance, its simplicity is useful in clinical practice.
Background: Nonalcoholic fatty liver disease (NAFLD) has been found to be a chronic and precarious metabolic complication from diabetes mellitus. Due to the limitation of treatment options for NAFLD, ...we postulated that SGLT2 inhibitors would have a potential benefit for NAFLD. None of the previous studies have comprehensively addressed multiple different classes of SGLT2 inhibitor in type 2 DM individuals with NAFLD. We conducted the first meta-analysis investigating the impact of SGLT2 inhibitors on liver function test in type2DM and NAFLD.
Methods: We comprehensively searched the databases of MEDLINE, EMBASE, and Cochrane databases. The inclusion criteria were published randomized control trials (RCT), prospective studies, and retrospective studies comparing SGLT2 inhibitors to placebo or controls in NAFLD and type 2 DM individuals. The primary outcome was the differences in the change of ALT and AST. We also examined the changes of NAFLD risk factors including body composition, lipid profile, HbA1C as secondary outcomes. Pooled odds ratio and 95% confidence interval were calculated using a random-effects model (generic inverse variance method). The between-study heterogeneity of effect size was quantified using the Q statistic and I.
Results: Eight RCTs, one prospective study, and one retrospective study with 4698 patients were included in the analysis. There was a statistically significant reduction of AST (MD=-2.09, 95% CI:-3.65to-0.52) and ALT (MD=-6.02, 95% CI: -8.35to-3.70) favoring SGLT2 inhibitor groups.
Conclusion: SGLT2 inhibitor groups were shown to have a statistically significant reduction of ALT and AST compared to placebo or control groups. SGLT2 inhibitor might be considered as a conjunctive treatment for NAFLD in type2DM individuals. Further studies regarding the optimal dosage and duration of SGLT2 inhibitors are helpful to assess potentially favorable effects in type 2 DM individuals and NAFLD.
Disclosure
S. Thavaraputta: None. K. Wirunsawanya: None. P. Laoveeravat: None.
Purpose
Cecal intubation time (CIT) is an indicator for difficult colonoscopy which is associated with patients’ unpleasant experience as well as increased risk of complications. Several studies have ...attempted to identify predictors for prolonged CIT but those studies tended to be small which gave rise to inconsistent and underpowered results. This systematic review and meta-analysis was conducted to summarize all available data.
Methods
MEDLINE and EMBASE databases were searched through November 2017 for studies that investigated the factors for prolonged CIT. Only factors that were reported by at least three studies were included in the meta-analyses. Pooled mean difference (MD) and 95% confidence interval (CI) were calculated using random effects model. The between-study heterogeneity of effect size was quantified using the
Q
statistic and
I
2
.
Results
A total of nine studies involving 7131 patients were included. A total of six factors were analyzed. Patients with older age (≥ 65 versus < 65), female sex (versus male), low body mass index (BMI) (< 25 versus ≥ 25 kg/m
2
), and poor bowel preparation (versus fair to good) had significantly longer CIT. The presence of diverticulosis and prior abdominal surgery were not significantly associated with prolonged CIT.
Conclusions
The current meta-analyses have demonstrated that old age, female sex, low BMI, and poor bowel preparation were the predictors for prolonged CIT.
PDF
