Laparoscopic cholecystectomy remains the standard treatment for acute cholecystitis (AC) although it is always not suitable for patients who are poor candidates for surgery. Recently, endoscopic ...gallbladder (GB) drainage was found to be a potentially revolutionary alternative for cholecystectomy for the control of symptoms, definitive treatment, or bridging therapy until surgery is possible. Two endoscopic methods have been established using either the trans‐mural or trans‐papillary drainage approach. Endoscopic ultrasound‐guided GB drainage (EUS‐GBD; trans‐mural approach) is a novel technique that allows stent placement between the GB and duodenum or stomach via fistula track, effectively enabling GB drainage. For endoscopic trans‐papillary GB drainage (ETGBD; trans‐papillary approach), attempts of selective cannulation to the cystic duct should be made to place the stent in the same manner as an endoscopic retrograde cholangiopancreatography. In comparison, EUS‐GBD has higher clinical success and lower recurrence rates than ETGBD due to the use of larger‐caliber stents, which allow for effective drainage when performed by skilled practitioners at high‐volume centers. Advantages of ETGBD over EUS‐GBD include more affordable costs and physiologic drainage, which preserves naive anatomy for possible future cholecystectomy. Although the field of endoscopic treatment for AC is rapidly advancing, important questions regarding which method improves clinical outcomes and safety more effectively remain unaddressed. Herein, the current status of endoscopic treatment for AC, including a technical review on clinical outcomes, adverse events, and advantages and disadvantages of each technique are reviewed, as well as other future prospects.
Abstract Purpose To investigate the correlation between the inner-retinal irregularity index and visual outcomes before and after idiopathic epiretinal membrane (ERM) surgery. Design Retrospective, ...cohort study. Methods We analyzed 66 eyes of 66 patients with idiopathic ERM. Ophthalmic examinations included best-corrected visual acuity (BCVA) measurements, metamorphopsia assessment, and spectral domain optical coherence tomography before surgery and 1, 3, and 6 months post-surgery. Correlations between the inner-retinal irregularity index, defined as the length ratio between the inner plexiform layer and retinal pigment epithelium, and visual outcomes before and after ERM surgery were evaluated and compared with the correlation between the central foveal thickness, ganglion cell–inner plexiform layer (GC–IPL) thickness, interdigitation zone defect, and visual outcomes. Results Inner-retinal irregularity index and central foveal thickness were significantly correlated with BCVA and metamorphopsia at each follow-up examination (all P < 0.05). The interdigitation zone defect correlated with BCVA at 3 and 6 months post-surgery (P < 0.001 and 0.015, respectively). However, GC–IPL thickness was not correlated with visual outcomes at any follow-up examination. The preoperative interdigitation zone defect was correlated with 6-month BCVA (P = 0.035) and the preoperative inner-retinal irregularity index was significantly correlated with the 6-month BCVA and marginally correlated with the 6-month metamorphopsia (P = 0.018 and P = 0.097, respectively). Conclusion The inner-retinal irregularity index was significantly correlated with visual outcomes before and after ERM surgery. This index can be used as a new surrogate marker for inner-retinal damage and a predictive prognostic marker in ERM.
To describe progressive tilting of the optic nerve head (ONH) and development/enlargement of parapapillary atrophy (PPA) observed in children with incipient myopia and to investigate factors ...associated with such changes.
Retrospective, observational study.
This study included 118 eyes of 118 Korean children who were assessed by serial disc photography at intervals of 1 year or more.
All disc photographs were reviewed by 2 experienced ophthalmologists, and eyes were classified into 2 groups with respect to the change in the ONH appearance and development/enlargement of β-zone PPA: (1) ONH/PPA changed group and (2) ONH/PPA unchanged group. To quantify the ONH/PPA changes, the ratio of the horizontal to vertical disc diameter (HVDR) and the ratio of the maximum PPA width to vertical disc diameter (PVDR) were measured. Factors associated with ONH/PPA changes were evaluated using logistic regression analysis. Refractive errors were measured with cycloplegic refraction.
Morphologic changes of the ONH/PPA as observed in serial disc photographs and its association with myopic shift.
Mean subject age and refractive error at the time of initial fundus examination were 7.3 ± 3.7 years (range, 1-17 years) and -0.9 ± 1.9 diopters (range, -5.9 to +3.0 diopters), respectively. Mean follow-up period was 38.1 ± 19.6 months (range, 12-88 months). Fifty-one eyes (43%) were classified as the ONH/PPA change group. In the ONH/PPA change group, HVDR decreased from the initial value of 0.92 ± 0.08 to the final value of 0.86 ± 0.11, and the PVDR increased from the initial value of 0.08 ± 0.07 to the final value of 0.20 ± 0.11. The ONH/PPA changes were most remarkable in subjects between 7 and 9 years of age (odds ratio OR = 6.698; 95% confidence interval CI, 2.296-19.546) and were associated with greater myopic shift during the follow-up period (OR = 0.483; 95% CI, 0.345-0.676).
We demonstrate progressive tilting of the ONH, which was observed with development/enlargement of PPA in children who exhibited myopic shift. These findings suggest that tilted disc, as well as PPA, may be an acquired feature in myopic eyes, arising from scleral stretching.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
To define the incidence and demographics of clinically diagnosed central retinal artery occlusion (CRAO) in Korea.
Nationwide population-based retrospective study using data entered into the Korean ...national health claims database from 2007 to 2011.
Data of the entire Korean population (N = 47,990,761, based on the 2010 census) were analyzed.
We used the national health claims database to identify patients diagnosed with CRAO. Incident cases were those with no claims related to CRAO in 2007 and were included once on the earliest claims related to CRAO in the years 2008 to 2011. Incident cases had a disease-free period before diagnosis of at least 1 to 4 years. The average incidence rate of CRAO was estimated according to the entire Korean population.
The person-time incidence rates of clinically diagnosed CRAO in Korea, including the age- and sex-specific incidence rates, were estimated.
A total of 3464 CRAO cases (59.1% men) were identified. The incidence rate of clinically diagnosed CRAO during the study period was 1.80 per 100,000 person-years (95% confidence interval CI, 1.74-1.86). The incidence rate among men and women was 2.15 (95% CI, 2.05-2.24) and 1.47 (95% CI, 1.39-1.54) per 100,000 person-years (male-to-female ratio, 1.47), respectively. The age-specific male-to-female ratios were constant between the ages of 30 and 89 years (range, 1.51-2.10 years). The highest incidence of 10.08 (95% CI, 8.80-11.35) per 100,000 person-years was observed in those aged 80 to 84 years (14.65 95% CI, 11.90-17.40 and 8.00 95% CI, 6.63-9.37 per 100,000 person-years for men and women aged 80-84 years, respectively). The incidence rate of CRAO increased exponentially with age until the 9th decade of life.
To our knowledge, this is the first nationwide epidemiologic study of CRAO in individuals of all ages. The incidence rate of CRAO in Korea increased exponentially with increasing age and was highest among those aged 80 to 84 years. Moreover, the incidence rate in men was 1.47 times higher than that in women.
To evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for treatment of neovascular age-related macular degeneration (nAMD) in vitrectomized eyes.
The ...medical records were reviewed of nAMD patients treated with anti-VEGF agents who previously underwent pars plana vitrectomy (PPV). PPV was performed with complete posterior vitreous detachment induction.
A total of 44 eyes from 44 patients were included. The mean central foveal thickness (CFT) was 478.50 ± 156.93 μm at baseline, 414.25 ± 143.55 μm (86.6% of baseline) at 1 month after first injection (P < 0.001), and 386.75 ± 141.45 μm (80.8% of baseline) after monthly multiple injections (2.30 ± 1.07; range, 1-5) (P < 0.001). The mean logarithm of the minimum angle of resolution best-corrected visual acuity visual acuity (BCVA) was 0.85 ± 0.57 at baseline, 0.86 ± 0.63 after the first injection, and 0.84 ± 0.64 after monthly multiple injections. BCVA improved in 39.5% at 1 month after first injection and 45.2% at 1 month after monthly multiple injections. In the subgroup analysis, CFT of eyes with the posterior capsule decreased significantly to 85.8% and 79.8% of baseline values at 1 month after the first injection and after monthly multiple injections, respectively. CFT of eyes without the posterior capsule decreased to 91.6% and 87.4% of baseline values at 1 month after the first injection and after monthly multiple injections, respectively, without statistical significance.
Monthly injections of Intravitreal anti-VEGF agents induced favorable anatomical improvement and vision maintenance in vitrectomized eyes with nAMD.
Background/Aims: Bisphosphonates are increasingly recognized for their anti-neoplastic properties, which are the result of their action on the mevalonate pathway. Our primary aim was to investigate ...the association between bisphosphonate use and survival in patients with pancreatic cancer. Since statins also act on the mevalonate pathway, we also investigated the effect of the combined use of bisphosphonates and statins on survival. Methods: The Surveillance, Epidemiology, and End Results : registry (SEER)-Medicare linked database was used to identify patients with pancreatic ductal adenocarcinoma (PDAC) between 2007 and 2015. Kaplan-Meier models were used to examine the association between survival with bisphosphonate use alone and in combination with statins within 1 year prior to the diagnosis of PDAC. Propensity score matching analysis and Cox-proportional hazard models were used to determine the association between overall survival with bisphosphonate use alone and combined with statins, after adjusting for relevant confounders, such as the Charlson comorbidity index score, stage, treatment, sociodemographic characteristics, and propensity score. Results: In total, 13,639 patients with PDAC were identified, and 1,203 (8.82%) used bisphosphonates. There was no difference in the mean survival duration between bisphosphonate users (7.27 months) and nonusers (7.25 months, p=0.61). After adjustment for confounders, bisphosphonate use was still not associated with improved survival (hazard ratio, 1.00; 95% confidence interval, 0.93 to 1.08; p=0.96). Combined bisphosphonate and statin use was also not associated with improved survival (hazard ratio, 0.97; 95% confidence interval, 0.87 to 1.07; p=0.48) after adjustment for confounders. Conclusions: Our findings suggest that the use of bisphosphonates, whether alone or in combination with statins, does not confer a survival advantage in patients with PDAC.
Background/Aims: The combinatorial effects of prophylactic methods for postendoscopic retrograde cholangiopancreatography pancreatitis (PEP) in patients with risk factors remain unclear. In this ...network meta-analysis, we compared the efficacy of various prophylactic strategies to decrease the risk of PEP among patients with risk factors. Methods: A systematic review was performed to identify randomized controlled trials from PubMed, Embase, and the Cochrane Library through July 2021. We used frequentist network meta-analysis to compare the rates of PEP among patients who received prophylactic treatments as follows: class A, rectal nonsteroidal anti-inflammatory drugs; class B, prophylactic pancreatic stent; class C, aggressive hydration; or control, no prophylaxis or active control. We selected those studies that included patients with risk factors for PEP. Results: We identified 19 trials, comprising 4,328 participants. Class ABC (odds ratio OR, 0.08; 95% confidence interval CI, 0.03 to 0.24), class AC (OR, 0.10; 95% CI, 0.02 to 0.47), class AB (OR, 0.12; 95% CI, 0.05 to 0.26), class BC (OR, 0.13; 95% CI, 0.04 to 0.41), class A (OR, 0.16; 95% CI, 0.05 to 0.50), and class B (OR, 0.26; 95% CI, 0.14 to 0.46), were associated with a reduced risk of PEP as compared to that of the control. The most effective prophylaxis was ABC (0.87), followed by AC (0.68), AB (0.65), BC (0.56), A (0.49), and B (0.24) according to P-score. Conclusions: The results of this network meta-analysis suggest that the more prophylactic methods are employed, the better the outcomes. It appears that for patients with risk factors, we need to prevent PEP through the use of these well proven combination strategies.
We aimed to investigate the prevalence of diabetic retinopathy (DR) in patients with diabetic foot ulcer (DFU) and elucidate the association between DR and DFU severities and their shared risk ...factors.
A retrospective review was conducted on DFU patients who underwent ophthalmic and vascular examinations within 6 months; 100 type 2 diabetic patients with DFU were included. The medical records of 2496 type 2 diabetic patients without DFU served as control data. DR prevalence and severity were assessed in DFU patients. DFU patients were compared with the control group regarding each clinical variable. Additionally, DFU patients were divided into two groups according to DR severity and compared.
Out of 100 DFU patients, 90 patients (90%) had DR and 55 (55%) had proliferative DR (PDR). There was no significant association between DR and DFU severities (R = 0.034, p = 0.734). A multivariable analysis comparing type 2 diabetic patients with and without DFUs showed that the presence of DR OR, 226.12; 95% confidence interval (CI), 58.07-880.49; p < 0.001 and proliferative DR OR, 306.27; 95% CI, 64.35-1457.80; p < 0.001), higher HbA1c (%, OR, 1.97, 95% CI, 1.46-2.67; p < 0.001), higher serum creatinine (mg/dL, OR, 1.62, 95% CI, 1.06-2.50; p = 0.027), older age (years, OR, 1.12; 95% CI, 1.06-1.17; p < 0.001), higher pulse pressure (mmHg, OR, 1.03; 95% CI, 1.00-1.06; p = 0.025), lower cholesterol (mg/dL, OR, 0.94; 95% CI, 0.92-0.97; p < 0.001), lower BMI (kg/m2, OR, 0.87, 95% CI, 0.75-1.00; p = 0.044) and lower hematocrit (%, OR, 0.80, 95% CI, 0.74-0.87; p < 0.001) were associated with DFUs. In a subgroup analysis of DFU patients, the PDR group had a longer duration of diabetes mellitus, higher serum BUN, and higher serum creatinine than the non-PDR group. In the multivariable analysis, only higher serum creatinine was associated with PDR in DFU patients (OR, 1.37; 95% CI, 1.05-1.78; p = 0.021).
Diabetic retinopathy is prevalent in patients with DFU and about half of DFU patients had PDR. No significant association was found in terms of the severity of these two diabetic complications. To prevent blindness, patients with DFU, and especially those with high serum creatinine, should undergo retinal examinations for timely PDR diagnosis and management.
To define the incidence and demographic characteristics of rhegmatogenous retinal detachment (RRD) requiring surgery in Korea.
Nationwide population-based retrospective study.
Patients who underwent ...surgery for RRD from 2007 to 2011 were retrospectively identified using the diagnostic code for RRD and the surgical codes for retinal detachment surgeries in the national claim database. The average incidence rate of RRD during the 5-year period was estimated using the population data of the 2010 Census in Korea.
A total of 24,928 surgically treated RRD cases were identified. The average incidence of surgery requiring RRD was 10.39 cases per 100,000 person-years 95% confidence interval (CI), 10.26-10.52). The incidence in men (11.32 cases per 100,000 person-years; 95% CI: 11.13-11.51) was significantly higher than that in women (9.47 cases per 100,000 person-years; 95% CI: 9.29-9.64) (p<0.001). The incidence of surgery requiring RRD showed a bimodal distribution across age groups, with one peak (28.55 cases per 100,000 person-years; 95% CI: 27.46-29.67) representing patients between 65 and 69 years of age and the second peak (approximately 8.5 per 100,000 person-years) representing patients between 20 and 29 years of age. The male-to-female ratio was approximately 1.0 for the peak-incidence age groups, whereas the ratio was higher for the other age groups.
The incidence of RRD in the Korean population was similar to that reported previously, with the peak incidence being lower than that in the Caucasian population. The age-specific RRD incidence pattern in Korea followed a bimodal distribution.
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