Gastric peroral endoscopic myotomy (G-POEM) is used for refractory gastroparesis (RG) with good early-term but variable mid- and long-term outcomes. Limited data exist about candidates and long-term ...clinical and predictive factors. Our aim was to evaluate the 4-year follow-up efficacy and predictive factors in patients with RG.
Confirmed RG patients were included and evaluated between April 2017 and December 2021. Gastroparesis Cardinal Symptom Index (GCSI) score, retention percentage at 4 hours (RP4H), mean half-emptying time (MHET), and the 36-item short-form survey (SF-36) were performed at 1, 6, 12, 18, 24, 30, 36, 42, and 48 months.
After G-POEM, 374 patients with RG were included: 141 patients (37.7%) had diabetic gastroparesis (DG), 115 (30.7%) had idiopathic gastroparesis (IG), 102 (27.3%) had postsurgical gastroparesis (PSG), and 16 (4.3%) had other etiologies. After the 48-month evaluation, 102 patients completed follow-up (DG, 58; IG, 22; PSG, 18; other, 4). Before G-POEM, GCSI score, RP4H, and MHET were 3.84 ± .53, 44% (interquartile range IQR, 11-68), and 246 minutes (IQR, 150-368), respectively, and after the 48-month evaluation improved to 2.1 ± .70 (P < .001), 15.5% (IQR, 0-36; P = .021), and 135 minutes (IQR, 67-290; P = .045), respectively. At the 48-month evaluation, clinical success was 77.5%. DG showed the best outcomes (DG vs IG vs PSG vs other: 86.5% vs 72.5% P = .001 vs 72.1% P = .003 vs 68.8% P < .001). Long-term success predictors were DG (odds ratio OR, 5.113; 95% confidence interval CI, 1.643-5.981; P = .035), early diagnosis (OR, 2.455; 95% CI, 1.129-3.522; P = .042), nausea/vomiting (OR, 3.541; 95% CI, 1.881-5.511; P = .012), GCSI score at 6 months (1.5-2) (OR, 3.612; 95% CI, 2.122-5.317; P = .022), and RP4H <10% at 6 months (OR, 2.188; 95% CI, 1.435-4.233; P = .039).
G-POEM is an effective 4-year treatment in patients with RG, especially in DG, establishing a potential first-line therapy in these patients. However, randomized controlled clinical trials are needed to confirm these results. (Clinical trial registration number: NTC03126513.)
The agreement between capsule endoscopy (CE) and device-assisted enteroscopy (DAE) in tumors of the small-bowel (SB) may be high. However, other SB lesions such as ulcers and angioectasias seem to ...have more agreement between both procedures, compared to tumors or polyps. In the article published by Alventosa-Mateu C et al., an interesting case was presented of a patient with iron deficiency anemia secondary to two carcinoid ileum tumors, identified by CE and later biopsied and tattooed by DAE.
retention is the most common adverse event of the small bowel capsule endoscopy procedure. Patency capsule (Medtronic, Dublin, Ireland) and magnetic resonance enterography are two diagnostic methods ...that can prevent small bowel capsule endoscopy retention. The aim of this study was to evaluate the predictive value of these two diagnostic methods.
a prospective, comparative and observational study was performed in patients with established Crohn's disease. All patients had undergone magnetic resonance enterography and patency capsule procedures. If the patency capsule was not retained, the patient underwent a small bowel capsule endoscopy; otherwise, double balloon enteroscopy was performed to locate the stenosis. Magnetic resonance enterography predictive criteria for retention were analyzed in all cases. Sensitivity, specificity, positive predictive value and negative predictive value of the patency capsule and magnetic resonance enterography compared to small bowel capsule endoscopy or double balloon enteroscopy were calculated.
forty patients were included (24 female, 55 ± 13 years old). Retention criteria with capsule endoscopy or double balloon enteroscopy were found in six patients, agreeing in five cases with patency capsule and in three cases with magnetic resonance enterography. Sensitivity, specificity, positive predictive value, negative predictive value and Kappa coefficient for predicting retention with the patency capsule were 83 %, 100 %, 100 % and 97 %, respectively, and 50 %, 91 %, 50 % and 91 %, respectively, with magnetic resonance enterography.
patency capsule has a higher sensitivity and positive predictive value than magnetic resonance enterography for preventing small bowel capsule endoscopy retention in Crohn's disease patients.
the aim of this study was to determine the risk factors for rebleeding following device-assisted enteroscopy therapy of small bowel vascular lesions.
this is a systematic review and meta-analysis. A ...literature search was performed from January 2003 to October 2019. All studies reporting on at least one risk factor for bleeding recurrence after endoscopic therapy of small bowel vascular lesions were included. A meta-analysis of those risk factors reported in at least three studies was performed to assess their association with rebleeding. The OR and 95 % CI were used for binary outcome data. Heterogeneity analysis was performed using the Tau and I2 index. If I2 > 20 %, potential sources of heterogeneity were identified by sensitivity analyses and a random-effect model was used.
the search identified a total of 572 articles and 35 full-text records were assessed for eligibility after screening. Finally, eight studies that included 548 patients were selected. The overall median rebleeding rate was 38.5 % (range: 10.9-53.3 %) with a median follow-up of 24.5 months. Female sex (OR: 1.96, 95 % CI: 1.14-3.37, p = 0.01, I2 = 0 %), Osler-Weber syndrome (OR: 4.35, 95 % CI: 1.22-15.45, p = 0.02, I2 = 0 %) and cardiac disease (OR: 1.89, 95 % CI: 1.12-2.97, p = 0.005, I2: 0 %) were associated with rebleeding. According to the sensitivity analysis, overt bleeding (OR: 2.13, 95 % CI: 1.22-3.70, p = 0.007, I2 = 0 %), multiple lesions (OR: 4.57, 95 % CI: 2.04-10.22, p < 0.001, I2 = 0 %) and liver cirrhosis (OR: 2.61, 95 % CI: 1.11-6.13, p = 0.03, I2 = 0 %) were also predictors for rebleeding.
patient characteristics and comorbidities should be considered for follow-up patient management after effective device-assisted endoscopic therapy, as they can predict rebleeding.
new alternatives for entry site closure (ESC) in per-oral endoscopy myotomy (POEM) and gastric peroral endoscopy myotomy (G-POEM) have appeared.
to compare the over-the-scope-clip (OTSC®) and ...conventional clips (CC) for ESC in POEM and G-POEM.
a retrospective review of a prospective POEM and G-POEM database was performed between January 2015 and August 2019. A description was made of outcomes, using either OTSC® or CC for submucosal tunnel closure.
forty-six POEM and 26 G-POEM were included in the study (23/13 per group CC/OTSC®). There were no clinical or procedure differences. ESC was performed with 1 OTSC® vs 5 CC and 1 vs 6 (p = 0.01) for POEM and G-POEM, respectively. Adverse events associated with clips were 21.7% vs 13% (p = 0.01) and 7.7% vs 0% (p = 0.02) for CC and OTSC® in POEM and G-POEM, respectively.
OTSC® represents a safe and effective alternative for entry site closure in POEM and G-POEM cases. Further studies are needed to recommend OTSC® as the first option for submucosal tunnel closure in these procedures.
the relationship between small bowel transit time (SBTT) of the capsule endoscopy (CE) and the diagnosis of small bowel bleeding (SBB) is controversial.
to evaluate the relationship between SBTT and ...CE and the identification of SBB.
CE was divided according to SBTT into < 4 hours and ≥ 4 hours.
CE with SBTT ≥ 4 hours identified more angioectasias (p = 0.023), single lesions (p = 0.029) and jejunal lesions (p = 0.001) with an OR of 3.13 (95% CI, 1.61-6.10, p = 0.001) to identify the cause of SBB.
CE SBTT of ≥ 4 hours increases the diagnosis of SBB.
studies have examined the agreement between capsule endoscopy and double-balloon enteroscopy, with varying results. The aim of this study was to identify factors that predict the visualization of ...lesions in the small bowel by double-balloon enteroscopy after a positive capsule endoscopy.
a retrospective, observational and comparative study was performed that evaluated patients that underwent double-balloon enteroscopy after a positive capsule endoscopy, between January 2017 and August 2019. The data studied included demographics, indications, comorbidities and the results of capsule endoscopy and double-balloon enteroscopy, which were evaluated by multiple logistic regression.
91 patients were included (age 58 ± 16.5 years, 53 female). Sixty-two double-balloon enteroscopy (68.1 %) found the same lesions as capsule endoscopy. Predictive factors for a positive double-balloon enteroscopy were multiple lesions (OR 8.10, 1.50-43.78; p = 0.015) and < 15 days between both studies (OR 5.31, 1.19-23.66; p=0.029). In the subgroup of patients with small bowel bleeding (70 patients), the results of 46 double-balloon enteroscopies (65.7 %) agreed with the capsule endoscopy. Predictive factors in this group were multiple lesions (OR 13.51, 1.78-102.22; p = 0.012), < 15 days between both studies (OR 13.51, 1.78-102.22; p = 0.012), > 60 years of age (OR 7.45, 1.51-36.75; p = 0.014) and ulcers (OR 4.67, 1.08-20.22; p = 0.039).
predictive factors for a positive double-balloon enteroscopy after a positive capsule endoscopy were multiple lesions and < 15 days between both procedures. In patients with small bowel bleeding, age over 60 years and the presence of ulcers were also predictive factors.
The use of pancreatic prostheses in children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP) has evolved. The main established indication is the treatment of persistent ...abdominal pain. This study aimed to evaluate the efficacy of pancreatic stenting for refractory abdominal pain in pediatric patients with ARP and CP.
We conducted a retrospective case series study. We included patients under 16 years of age diagnosed with ARP and CP in the study. Endoscopic retrograde cholangiopancreatography (ERCP) was performed with the insertion of one and later two pancreatic stents. We evaluated abdominal symptoms before and after treatment, number of changes, duration of treatment, and complications with follow-up at 24 months and after withdrawal.
Nine patients with ARP and CP were included in the study: six with undetermined etiology and three with pancreas divisum. The mean age was 12.4 years. Prosthesis placement relieved abdominal pain in 100% of cases, with 3.2 replacement sessions every 6.2 months for 27.4 months, and mild complications (15.7%). One patient experienced pain on removal of the prosthesis and required bypass surgery.
Pancreatic stent placement in patients with refractory abdominal pain with ARP and CP proved to be effective and safe, providing medium-term symptom relief and minimal complications.
the prevalence of small bowel (SB) polyps is unknown in acromegaly patients.
to evaluate the prevalence of polyps/tumors in SB of acromegaly patients.
this was a prospective and observational study ...that compared the prevalence of polyps/tumors using capsule endoscopy with a standard protocol in asymptomatic acromegaly patients and non-acromegaly patients, with abdominal pain, diarrhea or anemia.
one hundred and eighty-three cases were included (61 acromegaly and 122 non-acromegaly). Polyps were found in six (9.8%) and three (2.5%) patients, respectively (RR: 4 95% CI, 1.03-15.45; p = 0.038). There were no differences in the tumors (n = 4, 6.6% vs n = 7, 5.7%).
acromegaly may be associated with more polyps in SB.
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