Aims Peroral endoscopic myotomy (POEM) is a novel minimally invasive intervention for treating esophageal achalasia. Previous publications have proved its excellent efficacy and safety, and even shown it could improve patients’ quality of life (QoL). However, there has been no meta-analysis to review the effect of POEM for QoL in patients. Therefore, we conducted this study to explore the changes of QoL following POEM.
Background and Aims . Recently, a new type of metal stent, named lumen-apposing metal stents (LAMS), has been designed to manage pancreatic fluid collections (PFC), and a few studies have reported its efficacy and safety. Therefore, we conducted this meta-analysis to investigate the role of LAMS for PFC. Methods . We searched the studies from PubMed, MEDLINE, Embase, and Cochrane databases from inception to May 2019. We extracted the data and analyzed the technical success, clinical success, and adverse events of LAMS to evaluate its efficacy and safety. Results . Twenty studies with 1534 patients were included. The pooled technical success, clinical success, and adverse event rates of LAMS for PFC were 96.2% (95% confidence interval (CI): 94.6%-97.4%), 86.8% (95% CI: 83.1%-89.8%), and 20.7% (95% CI: 16.1%-26.1%), respectively. Eight studies including 875 patients compared the clinical outcomes of LAMS with plastic stents. The pooled risk ratio (RR) of technical success and clinical success for LAMS and plastic stent was 1.01 (95% CI: 0.98-1.04, P=0.62) and 1.06 (95% CI: 1.01-1.12, P=0.03), respectively. As for the overall adverse events, the pooled RR was 1.51 (95% CI: 0.67-3.44, P=0.32). Conclusions . Our current study revealed that LAMS has advantages over plastic stents for PFC, with higher clinical success rate and lower complication rate of infection and occlusion.
Because the number of published literatures with a focus on Barrett's esophagus (BE) that researchers must be familiar with has quickly increased in recent years, the significance of selective searching and summarization of bibliometrics is also increasing. It is, thus, very important to find a method that can quickly and effectively search the most influential medical science articles. Therefore, the objective of this study was to use bibliometric analysis to assess and characterize the most influential articles involving BE research.Publications on BE research were retrieved from the Web of Science Core Collection using the term "Barrett's esophagus." Microsoft Excel 2016 and VOSviewer were used to further analyzed each article's citation number, title, journal, country, organization, category, and authorship.On 14 June 2020, 5,389 records of BE research published until 2020 were retrieved. The citation number of the top 100 most-cited articles ranged from 208 to 824. Gastroenterology published 29 articles, which accounted for the largest number of top 100 articles (29%); however, among the top 500 most-cited articles, the American Journal of Gastroenterology published the largest number. Of the top-cited articles, the USA was by far the leading country in BE research and contributed most of the articles (n = 72). Among the academic institutions that produced the top 100 most-cited articles, the University of Washington (n = 12) was dominant. Sharma Prateek (n = 6) authored the largest number of most-cited articles. The USA contributed the most articles per year, and the time trend of the number of top 500 articles increased by 38-fold between 1987 and 2000. "Adenocarcinoma," "high-grade dysplasia," "cancer," "diagnosis," and "dysplasia" were the most influential keywords.This study not only presents a historical perspective but also facilitated the recognition of the significant advances in this area by researchers. Furthermore, the current study serves as a guide in decision clinical practice decision-making and provides a valuable reference for further research.
Background and aims Recently, endoscopic ultrasound (EUS)-guided ablation therapy, as a minimally invasive technique, has shown its potential to substitute surgery in treating solid pancreatic tumors, such as small potential malignant pancreatic tumors, small insulinomas and locally advanced pancreatic ductal adenocarcinoma (LAPDAC). Therefore, we conducted this systematic review to assess the safety and efficacy of EUS-guided ablation therapy for solid pancreatic tumors.Methods We conducted a comprehensive search of PubMed, Embase, Cochrane library and Web of Science databases from inception to February 2020. The endpoints were clinical success and complications rates. The pooled event rate was calculated using Comprehensive Meta Analysis software.Results Fourteen studies with a total of 158 patients were included in our final analysis. The major types of solid pancreatic tumors were nonfunction pancreatic neuroendocrine tumors (n = 78, 49.4%), LAPDAC (n = 48, 30.4%) and insulinomas (n = 26, 16.5%). Overall, the pooled clinical success rate was 85.9% (95% confidence interval (CI): 75.4–92.4%, I2 = 25.18%), pooled complications rate was 29.1% (95% CI: 18.6–42.3%, I2 = 50.40%). Subgroup analysis was performed based on ablation methods, which showed clinical success rate for radiofrequency ablation (RFA) was 83.5% (95% CI: 67.9–92.4%), and 87.9% (95% CI: 66.2–96.4%) for ethanol ablation (EA). In terms of complications rate, it was 32.2% (95% CI: 19.4–48.4%) for RFA, and 21.2% (95% CI: 6.8–49.9%) for EA.Conclusions EUS-guided ablation therapy is a promising alternative treatment for solid pancreatic tumors, especially for p-NETs and insulinomas < 2 cm, with rarely severe complications. Further prospective studies with long-term follow-up are warranted in future.
Background: Binostril endoscopic transsphenoidal approach (BETA) is the most common used surgery for pituitary adenoma and is very efficient for eradicating the lesions. Most patients have a good prognosis while its damage to nasal cavity and postoperative olfactory dysfunction remain controversial. With refinement of modern surgery, more attention should be paid to patients’ quality of life and preserving the function of olfactory after skull base surgery. Hence, we introduced the one-and-a-half nostril endoscopic transsphenoidal approach (OETA) in 2016 (shown in Table 1) which provided minimal invasion to the nasal cavity with expectation of improving patients’ quality of life postoperatively and registered a prospective randomized controlled clinical trial to assess this approach.
Aims Gastric peroral endoscopic pyloromyotomy (G-POEM) is a novel minimally invasive intervention for treating refractory gastroparesis. We conducted a systematic review and meta-analysis to determine the clinical success and safety of G-POEM.
Abstract Background: Approximately 30–40% of growth hormone-secreting pituitary adenoma (GHPA) harbor somatic mutations in the GNAS (α subunit of the stimulatory G protein) gene. However, the latent functional role of the mutations and relative molecular mechanism in GHPA remain unknown. Methods: The GNAS gene mutations were detected in GHPAs using a standard PCR-sequencing procedure. The mutation-associated MEG3 expression was measured by RT-qPCR. MEG3 was manipulated in GH3 cells using a lentiviral expression system. Alterations in mRNA profiles in the MEG3-overexpressed cells were analyzed by RNA-seq. The cell invasion ability was measured using a Transwell assay, and the EMT-associated proteins were quantified by immunofluorescence and western blot. Finally, a tumor cell xenograft mouse model was applied to verify the effect of MEG3 on tumor growth and invasiveness. Results: The percentage of invasive tumors was significantly declined in GNAS -mutated GHPA tumors with the GNAS mutations compared to those tumors with the wild-type of GNAS . Consistently, the GH3 cell invasion capacity was decreased by expressing the mutant GNAS . MEG3 is uniquely expressed at high levels in GHPA harboring the mutated GNAS gene. Accordingly, the upregulation of MEG3 resulted in inhibiting cell invasion; and vice versa, the downregulation of MEG3 led to enhancing cell invasion. Mechanistically, the high level of MEG3 in mutated GNAS cells prevented the cell invasion via inactivation of the Wnt/β-catenin signaling pathway, which was further validated in vivo. Conclusion: The GNAS mutations inhibit the invasiveness of GHPA cells via inactivation of the MEG3/Wnt/β-catenin signaling pathway.
Abstract Background: Conventional endoscopic treatments can’t control bleeding in as many as 20% of patients with non-variceal gastrointestinal (GI) bleeding. Recent studies have shown that over-the-scope-clip (OTSC) system allowed for effective hemostasis for refractory GI bleeding lesions. So we aimed to conduct a systematic review to evaluate the effectiveness and safety of the OTSC system for management of acute non-variceal upper GI bleeding. Method: A comprehensive literature search was conducted on PubMed, EMBASE, and Cochrane Library covering the period from January 2007 to May 2019. The literature was selected independently by two reviewers according to the inclusion and exclusion criteria. The statistical analysis was carried out using Comprehensive Meta-Analysis software version 3.0. Results: A total of 16 studies including 769 patients with 778 GI bleeding lesions were identified. Pooled technical success was achieved in 761 lesions [95.7%; 95% confidence interval (CI), 93.5%-97.2%], and the pooled clinical success was achieved in 666 lesions (84.2%; 95% CI, 77.4%-89.2%). The incidence of re-bleeding was reported in 81 patients and the post-procedure mortality was 10.9% (n = 84). Only 2 (0.3%) patients occurred complications after OTSC system procedure. Conclusions: Our study demonstrated that the OTSC system was a technically feasible modality and highly efficacious in achieving hemostasis in acute non-variceal upper gastrointestinal bleeding.
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