Objective: Angiotensin-converting-enzyme-inhibitors (ACEIs) and/or angiotensin-receptor-blockers (ARBs) are recommended by guidelines as first-line therapies for the management of hypertension in the general population. However, the cardioprotective benefit of these agents among patients on chronic dialysis remains uncertain. This meta-analysis aimed to explore the effect of ACEIs/ARBs on cardiovascular events in this high-risk patient population. Design and method: We searched Medline/PubMed and Cochrane database of clinical trials from inception through February 2022 to identify randomized controlled trials (RCTs) comparing the effect of ACEIs/ARBs relative to placebo or no add-on treatment in patients receiving dialysis. RCTs were eligible in quantitative data synthesis, if they were assessing fatal or non-fatal cardiovascular events as a primary efficacy endpoint. Results: We identified 5 RCTs including a total of 1,582 dialysis patients. As compared with placebo or no add-on treatment, the use of ACEIs/ARBs was not associated with a significantly lower risk of cardiovascular events [risk ratio (RR): 0.79; 95% confidence interval (CI): 0.57-1.11; I2 = 73%, P = 0.005]. Furthermore, there was no benefit of ACEIs/ARBs on cardiovascular mortality (RR: 0.82; 95% CI: 0.59-1.14; I2 = 6%, P = 0.37) and all-cause mortality (RR: 0.86; 95% CI: 0.64-1.15; I2 = 44%, P = 0.13). These results were consistent, when the included RCTs were stratified into subgroups according to the hypertension status and ethnicity of patients, sample size, duration of follow-up and method quality. Conclusions: The present meta-analysis showed that among patients on dialysis, the use of ACEIs/ARBs is not associated with a significantly lower risk of cardiovascular events and all-cause mortality as compared with placebo or no add-on treatment.
Introduction: COVID-19 significantly affected endoscopic practice, as gastrointestinal endoscopy is considered a risky procedure for transmission of infection to patients and personnel of endoscopy units (PEU). This multicenter study aimed to assess the impact of COVID-19 on endoscopy during the first European lockdown (March-May 2020). Aims & Methods: Patients undergoing endoscopy during the period of the first European lockdown for COVID-19 (March-May 2020) were included. Those deemed as low risk or negative for COVID-19 via polymerase chain reaction (PCR) testing were contacted 7-14 days later to assess infection status. Information for possible COVID-19 infection of PEU and number of weekly endoscopies in each center during the lockdown period were also recorded. Results: One thousand two hundred sixty-seven endoscopies were performed in 1222 individuals, across 9 European centers (6 countries). Among the 1135 pre-endoscopically low risk or PCR negative for COP0911 VID-19, 254 (22.4%) were tested post-endoscopy and 8 were eventually found positive, resulting in an infection rate of 0.7% (95%CI: 0.2-0.12). The majority (6 patients, i.e., 75%) turned positive after esophagogastroduodenoscopy (EGD). Of these, 4 (50%) were considered obviously irrelevant to endoscopy, but for the other 50% the route of transmission remained obscure. Data regarding 163 PEU was recorded;5 [3%;95%CI: 0.4-5.7) tested positive during the study period. In 4 of them (2% of the total), the infection was considered to be associated to their work environment. A decrease of 68.7% (95%CI: 64.8-72.7) in the number of weekly endoscopies was recorded in all centers after March 2020. All centers implemented appropriate personal protective measures (PPM) from the initial phases of the lockdown. Conclusion: COVID-19 transmission in endoscopic units is highly unlikely in a lockdown setting, provided endoscopies are reduced to emergency cases and PPM are implemented.
A variety of add-on devices and new-generation endoscopes have the potential to detect lesions 'hidden' behind colonic folds. We measured the effect of these new modalities on colonoscopy's lesions miss rates by a meta-analysis of data from individual studies.We performed literature searches in Medline and Cochrane Library for back-to-back randomized-controlled trials evaluating colonoscope add-on devices and new endoscopes in terms of lesions miss rates. The effect size on study outcomes is shown as relative risk (95% confidence interval).We identified nine tandem studies with 1594 patients: seven evaluating add-on devices (one with cap, two with Endocuff, one with Endorings, one with Third-Eye Retroscope, two with G-EYE endoscope) and two evaluating the full-spectrum endoscopy system (FUSE) in comparison with conventional colonoscopy (CC). Overall, adenoma miss rate (AMR) was significantly lower with add-on devices/FUSE [0.33 (0.22-0.50), P<0.00001] compared with CC, the effect being similar among the add-on devices [0.35 (0.22-0.57), P<0.0001] and the FUSE [0.26 (0.15-0.46), P<0.00001] studies, respectively. Advanced AMR and polyp miss rate (PMR) were also significantly lower using add-on devices/FUSE [0.30 (0.21-0.44), P<0.0001 and 0.31 (0.13-0.79), P=0.01, respectively]. Use of add-on devices/FUSE scope was associated with significantly lower AMR and PMR in the proximal colon and it was associated with shortening of the colonoscopy surveillance interval.Our meta-analysis provides evidence that AMR, advanced AMR, and PMR are significantly lower using add-on to colonoscope devices and the full-spectrum endoscopy systems compared with CC. Heterogeneity among the included studies and the small number of detected advanced adenomas call for cautious interpretation of the results.
Resected rectal polyps with deep invasion into the submucosa (pT1b-sm2,3) or the muscle layer (pT2) are currently confronted with surgery due to non-curative resection.
Background and Aims . Inpatients’ bowel preparation before colonoscopy is frequently inadequate, and various interventions have been investigated to improve it, so far. We aimed to evaluate the efficacy of various interventions to improve inpatients’ colon preparation quality. Methods . We systematically reviewed the literature for publications on interventions aiming to improve the quality of inpatients’ colon preparation until June, 2018. Significant heterogeneity—measured with I2—was detected at the level of P<0.1. Adequacy rates were measured using inverse variance, and the size effect of different interventions was calculated using random effects model and expressed as odds ratio (OR). Results . Seventeen studies enrolling 2733 inpatients were included. Overall, 67% (60-75%) of the participants achieved adequate colon cleansing (I2=97%; P<0.001). In six studies assessing the impact of educational interventions to patient/physician/nurse vs. no intervention, adequate bowel preparation was achieved in 77% (62-91%) vs. 50% (32-68%) of the patients (OR 95%CI=3.49 (1.67-7.28), P=0.0009; I2=74%; P=0.002). Ten studies examined variations (qualitative and/or quantitative) in bowel preparation regimens with adequate preparation detected in 71% (60-81%) of the participants, and a single study examined the administration of preparation through an esophagogastroduodenoscope, resulting in adequate prep in 71% of the patients. Conclusions . Despite several interventions, only two-thirds of inpatients achieve adequate colon preparation before colonoscopy. Educational interventions significantly improve inpatients’ bowel preparation quality.
Recent data imply young patients (age ≤50 years) undergoing small-bowel (SB) capsule endoscopy (CE) for iron deficiency anaemia (IDA) show higher diagnostic yield (DY) for sinister pathology. We aimed to investigate DY of CE in a large cohort of young IDA patients, and evaluate factors predicting significant SB pathology.
Abstract Background and study aims There is limited evidence on the diagnostic performance of endoscopic ultrasound (EUS)-guided tissue acquisition in autoimmune pancreatitis (AIP). The aim of this meta-analysis was to provide a pooled estimate of the diagnostic performance of EUS-guided fine-needle aspiration (FNA) and fine-needle biopsy (FNB) in patients with AIP. Patients and methods Computerized bibliographic search was performed through January 2020. Pooled effects were calculated using a random-effects model by means of DerSimonian and Laird test. Primary endpoint was diagnostic accuracy compared to clinical diagnostic criteria. Additional outcomes were definitive histopathology, pooled rates of adequate material for histological diagnosis, sample adequacy, mean number of needle passes. Diagnostic sensitivity and safety data were also analyzed. Results Fifteen studies with 631 patients were included, of which four were prospective series and one randomized trial. Overall diagnostic accuracy of EUS tissue acquisition was 54.7 % (95 % confidence interval, 40.9 %–68.4 %), with a clear superiority of FNB over FNA (63 %, 52.7 % to 73.4 % versus 45.7 %, 26.5 %–65 %; p < 0.001). FNB provided level 1 of histological diagnosis in 44.2 % of cases (30.8 %–57.5 %) as compared to 21.9 % (10 %–33.7 %) with FNA (P < 0.001). The rate of definitive histopathology of EUS tissue sampling was 20.7 % (12.9 %–28.5 %) and it was significantly higher with FNB (24.3 %, 11.8 %–36.8 %) as compared to FNA (14.7 %, 5.4 %–23.9 %; P < 0.001). Less than 1 % of subjects experienced post-procedural acute pancreatitis. Conclusion The results of this meta-analysis demonstrate that the diagnostic performance of EUS-guided tissue acquisition is modest in patients with AIP, with an improved performance of FNB compared to FNA.
Several add-on devices and new generation endoscopes promise to improve colonoscopy's outcomes by detecting polyps “hidden” behind the colonic folds. We aimed to measure the effect of these new modalities on colonoscopy's adenoma miss rate by meta-analyzing data from individual studies.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)