| 1. |
- Wang, Qiao-Li, et al.
(author)
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Prediction of individuals at high absolute risk of esophageal squamous cell carcinoma
- 2019
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In: Gastrointestinal Endoscopy. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0016-5107 .- 1097-6779.
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Journal article (peer-reviewed)abstract
- Background and Aims: This study aimed to develop a prediction model for identifying individuals at high absolute risk of esophageal squamous cell carcinoma (ESCC) for endoscopic screening at a curable stage based on readily identifiable risk factors. Methods: This was a nationwide Swedish population-based case-control study, including 167 new cases of ESCC and 820 randomly selected control participants. Odds ratios with 95% confidence intervals (CI) were assessed using multivariable unconditional logistic regression. The discriminative accuracy of the model was assessed by the area under the receiver operating characteristic curve (AUC) with leave-one-out cross-validation. Models for projecting individuals’ absolute 5-year risk of ESCC were developed by incorporating the age- and sex-specific incidence rates and competing risk of death from other causes. Results: A model including the risk factors age, sex, tobacco smoking, alcohol overconsumption, education, duration of living with a partner, and place of residence during childhood generated an AUC of 0.81 (95% CI 0.77-0.84). A model based only on age, sex, tobacco smoking, and alcohol overconsumption obtained a similar AUC (0.79, 95% CI 0.75-0.82). A 5-year follow-up of 355 men aged 70-74 years with over 35 years’ smoking and alcohol overconsumption history is needed to detect one ESCC case. The estimated individuals’ absolute 5-year risk of ESCC varied according to combinations of risk factors. Conclusions: This “easy-to-use” risk prediction model showed a good discriminative accuracy and had the potential to identify individuals at high absolute risk of ESCC who might benefit from tailored endoscopic screening and surveillance.
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| 10. |
- Baltes, Peter, et al.
(author)
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Small-bowel capsule endoscopy in patients with Meckel's diverticulum : clinical features, diagnostic workup, and findings. A European multicenter I-CARE study
- 2023
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In: Gastrointestinal Endoscopy. - : Elsevier BV. - 0016-5107. ; 97:5, s. 3-926
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Journal article (peer-reviewed)abstract
- Background and Aims: Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. Methods: This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021. Results: Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n = 49 [71%]), visible entrance into the MD (n = 49 [71%]), mucosal webs (n = 30 [43.5%]), and bulges (n = 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n = 36). In 63.8% of patients (n = 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n = 27). Mean percent SB (small bowel) transit time for the first indicative image of MD was 57% of the total SB transit time. Conclusions: Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.
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- Burnand, B, et al.
(author)
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Use, appropriateness, and diagnostic yield of screening colonoscopy: an international observational study (EPAGE)
- 2006
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In: Gastrointestinal Endoscopy. - : Elsevier BV. - 1097-6779 .- 0016-5107. ; 63:7, s. 1018-1026
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Journal article (peer-reviewed)abstract
- Abstract in UndeterminedBackgroundScreening for colorectal cancer (CRC) has been shown to decrease mortality.ObjectiveTo examine determinants associated with having (1) a screening colonoscopy, (2) an appropriate indication for screening, and (3) a significant diagnosis at screening.DesignProspective observational study.SettingTwenty-one endoscopy centers from 11 countries.PatientsAsymptomatic patients who underwent a colonoscopy for the purpose of detecting CRC and who did not have a history of polyps or CRC, a lesion observed at a recent barium enema or sigmoidoscopy, or a recent positive fecal occult blood test.InterventionScreening colonoscopy.Main Outcome MeasurementsAppropriateness according to the European Panel on the Appropriateness of Gastrointestinal Endoscopy (EPAGE) criteria and significant diagnoses (cancer, adenomatous polyps, new diagnoses of inflammatory bowel disease, angiodysplasia).ResultsOf 5069 colonoscopies, 561 (11%) were performed for screening purposes. Patients were more likely to have a screening colonoscopy if they were aged 45 to 54 years (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.60-3.99). Screening colonoscopies were appropriate, uncertain, and inappropriate in 26%, 60%, and 14% of cases, respectively. Eighty-one significant diagnoses were made, including 4 cancers. Significant diagnoses were more often made for uncertain/appropriate indications (OR 3.20, 95% CI 1.12-9.17) than for inappropriate indications.LimitationsAlthough data completeness was asked of all centers, it is possible that not all consecutive patients were included. Participating centers were a convenience sample and thus may not be representative.ConclusionsAbout 1 of 10 colonoscopies were performed for screening, preferentially in middle-aged individuals. A higher diagnostic yield in uncertain/appropriate indications suggests that the use of appropriateness criteria may enhance the efficient use of colonoscopy for screening.
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| 16. |
- Cadoni, Sergio, et al.
(author)
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Water-assisted colonoscopy: an international modified Delphi review on definitions and practice recommendations
- 2021
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In: Gastrointestinal Endoscopy. - : Elsevier BV. - 1097-6779 .- 0016-5107. ; 93:6, s. 1411-1420
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Journal article (peer-reviewed)abstract
- Background and Aims: Since 2008, a plethora of research studies has compared the efficacy of water-assisted (aided) colonoscopy (WAC) and underwater resection (UWR) of colorectal lesions with standard colonoscopy. We reviewed and graded the research evidence with potential clinical application. We conducted a modified Delphi consensus among experienced colonoscopists on definitions and practice of water immersion (WI), water exchange (WE), and UWR. Methods: Major databases were searched to obtain research reports that could potentially shape clinical practice related to WAC and UWR. Pertinent references were graded (Grading of Recommendations, Assessment, Development and Evaluation). Extracted data supporting evidence-based statements were tabulated and provided to respondents. We received responses from 55 (85% surveyed) experienced colonoscopists (37 experts and 18 nonexperts in WAC) from 16 countries in 3 rounds. Voting was conducted anonymously in the second and third round, with ≥80% agreement defined as consensus. We aimed to obtain consensus in all statements. Results: In the first and the second modified Delphi rounds, 20 proposed statements were decreased to 14 and then 11 statements. After the third round, the combined responses from all respondents depicted the consensus in 11 statements (S): definitions of WI (S1) and WE (S2), procedural features (S3-S5), impact on bowel cleanliness (S6), adenoma detection (S7), pain score (S8), and UWR (S9-S11). Conclusions: The most important consensus statements are that WI and WE are not the same in implementation and outcomes. Because studies that could potentially shape clinical practice of WAC and UWR were chosen for review, this modified Delphi consensus supports recommendations for the use of WAC in clinical practice. © 2020 American Society for Gastrointestinal Endoscopy
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| 19. |
- Dray, Xavier, et al.
(author)
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Feasibility and diagnostic yield of small-bowel capsule endoscopy in patients with surgically altered gastric anatomy : the SAGA study
- 2021
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In: Gastrointestinal Endoscopy. - : Elsevier BV. - 0016-5107. ; 94:3, s. 1-597
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Journal article (peer-reviewed)abstract
- Background and Aims: Little is known about small-bowel (SB) capsule endoscopy (CE) in patients with a history of gastric surgery. This study aims to evaluate the feasibility and diagnostic yield (DY) of orally ingested SB-CE in patients with surgically altered gastric anatomy. Methods: Twenty-four European centers retrospectively identified patients who had SB-CE after total or subtotal gastrectomy. The primary outcome was the DY of SB-CE (intermediate P1 to highly P2 relevant findings). Secondary outcomes were gastric and SB transit times, completion, cleanliness, and adverse event rates. Results: Studied were 248 procedures from 243 patients (mean age, 62 years) with a history of partial gastrectomy (Billroth I, 13.1%; Billroth II, 34.6%), total gastrectomy (7.4%), Whipple procedure (12.8%), sleeve gastrectomy (7.2%), or gastric bypass surgery (24.7%). Obscure GI bleeding was the most frequent indication (85.1%). SB completion rate was 84.3%. One capsule retention in the SB was noted (adverse event rate,.4%). Median SB transit time was 286 minutes (interquartile range [235; 387]). Cleanliness was rated as adequate in 92.1% of procedures. After exclusion of abnormalities found at the upper anastomotic site, the DY was 43.6%, with inflammatory/ulcerated lesions observed more frequently (23.4%) than vascular lesions (21.0%). Conclusions: SB-CE seems to be feasible and safe in selected patients with a history of major gastric surgery and comes with a high DY. The spectrum of abnormal SB findings in these patients may be different from what is known from the literature in nonoperated patients.
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| 23. |
- Hansson, MR, et al.
(author)
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BIMODAL ERCP, A NEW WAY OF SEEING THINGS
- 2019
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In: GASTROINTESTINAL ENDOSCOPY. - : Elsevier BV. - 0016-5107. ; 89:6, s. AB249-AB250
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Conference paper (other academic/artistic)
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| 25. |
- Haraldsson, Erik, 1972, et al.
(author)
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Macroscopic appearance of the major duodenal papilla influences bile duct cannulation: a prospective multicenter study by the Scandinavian Association for Digestive Endoscopy Study Group for ERCP
- 2019
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In: Gastrointestinal Endoscopy. - : Elsevier BV. - 0016-5107 .- 1097-6779. ; 90:6, s. 957-963
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Journal article (peer-reviewed)abstract
- Background and Aims: Certain appearances of the major duodenal papilla have been claimed to make cannulation more difficult during ERCP. This study uses a validated classification of the endoscopic appearance of the major duodenal papilla to determine if certain types of papilla predispose to difficult cannulation. Methods: Patients with a naïve papilla scheduled for ERCP were included. The papilla was classified into 1 of 4 papilla types before cannulation started. Time to successful bile duct cannulation, attempts, and number of pancreatic duct passages were recorded. Difficult cannulation was defined as after 5 minutes, 5 attempts, or 2 pancreatic guidewire passages. Results: A total of 1401 patients were included from 9 different centers in the Nordic countries. The overall frequency of difficult cannulation was 42% (95% confidence interval [CI], 39%-44%). Type 2 small papilla (52%; 95% CI, 45%-59%) and type 3 protruding or pendulous papilla (48%; 95% CI, 42%-53%) were more frequently difficult to cannulate compared with type 1 regular papilla (36%; 95% CI, 33%-40%; both P <.001). If an inexperienced endoscopist started cannulation, the frequency of failed cannulation increased from 1.9% to 6.3% (P <.0001), even though they were replaced by a senior endoscopist after 5 minutes. Conclusions: The endoscopic appearance of the major duodenal papilla influences bile duct cannulation. Small type 2 and protruding or pendulous type 3 papillae are more frequently difficult to cannulate. In addition, cannulation might even fail more frequently if a beginner starts cannulation. These findings should be taken into consideration when performing studies regarding bile duct cannulation and in training future generations of endoscopists. © 2019 American Society for Gastrointestinal Endoscopy
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| 27. |
- Haraldsson, E, et al.
(author)
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Response
- 2020
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In: Gastrointestinal endoscopy. - : Elsevier BV. - 1097-6779 .- 0016-5107. ; 91:4, s. 959-960
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Journal article (other academic/artistic)
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| 31. |
- James, Paul D., et al.
(author)
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Incremental benefit of preoperative EUS for the detection of pancreatic neuroendocrine tumors : a meta-analysis
- 2015
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In: Gastrointestinal Endoscopy. - : Elsevier BV. - 0016-5107 .- 1097-6779. ; 81:4, s. 848-
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Research review (peer-reviewed)abstract
- Background: Current guidelines recommend CT scan or magnetic resonance imaging as the initial imaging modalities for the work-up of suspected pancreatic neuroendocrine tumors (PNETs). Objective: To determine the incremental benefit of preoperative EUS (IBEUS) for the detection of suspected PNETs after other investigative modalities have been attempted. Design: This systematic review searched MEDLINE, EMBASE, bibliographies of included articles, and conference proceedings for studies reporting original data regarding the preoperative detection of PNETs. Pooled IBEUS was calculated by using random effects models. Heterogeneity was explored by using stratified meta-analysis and meta-regression. Evidence of small-study effects was assessed by using funnel plots and the Begg test. Patients: Patients with suspected PNETs. Interventions: EUS evaluation. Main Outcome Measurements: The pooled IBEUS for the detection of PNETs after CT scan, with or without additional investigative modalities. Results: Among 4505 citations identified, we included 17 cohort studies (612 patients). EUS identified PNETs in 97% of cases. Improved PNET identification with EUS was observed in all of the studies. After adjusting for small-study effects, meta-analysis showed that EUS alone could identify PNETs in approximately 1 in 4 patients (adjusted IBEUS 26%; 95% confidence interval, 17%-37%). The pooled IBEUS varied based on the study design, study size, type of CT scan used, and the number of modalities used prior to EUS. Limitations: The majority of included studies were retrospective. Small-study effects were observed. Conclusion: Preoperative EUS is associated with an increase in PNET detection after other modalities are attempted.
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| 37. |
- Kullman, Eric, et al.
(author)
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Covered versus uncovered self-expandable nitinol stents in the palliative treatment of malignant distal biliary obstruction: results from a randomized, multicenter study
- 2010
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In: GASTROINTESTINAL ENDOSCOPY. - : Elsevier Science B. V., Amsterdam. - 0016-5107 .- 1097-6779. ; 72:5, s. 915-923
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Journal article (peer-reviewed)abstract
- Background: Covered biliary metal stents have been developed to prevent tumor ingrowth. Previous comparative studies are limited and often include few patients. Objective: To compare differences in stent patency, patient survival, and complication rates between covered and uncovered nitinol stents in patients with malignant biliary obstruction. Design: Randomized, multicenter trial conducted between January 2006 and October 2008. Setting: Ten sites serving a total catchment area of approximately 2.8 million inhabitants. Patients: A total of 400 patients with unresectable distal malignant biliary obstruction. Interventions: ERCP with insertion of covered or uncovered metal stent. Follow-up conducted monthly for symptoms indicating stent obstruction. Main Outcome Measurements: Time to stent failure, survival time, and complication rate. Results: The patient survival times were 116 days (interquartile range 242 days) and 174 days (interquartile range 284 days) in the covered and uncovered stent groups, respectively (P = .320). The first quartile stent patency time was 154 days in the covered stent group and 199 days in the uncovered stent group (P = .326). There was no difference in the incidence of pancreatitis or cholecystitis between the 2 groups. Stent migration occurred in 6 patients (3%) in the covered group and in no patients in the uncovered group (P = .030). Limitations: Randomization was not blinded. Conclusions: There were no significant differences in stent patency time, patient survival time, or complication rates between covered and uncovered nitinol metal stents in the palliative treatment of malignant distal biliary obstruction. However, covered stents migrated significantly more often compared with uncovered stents, and tumor ingrowth was more frequent in uncovered stents.
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| 42. |
- Lindström, Eva, et al.
(author)
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Pin within a bile duct stone.
- 2002
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In: Gastrointestinal Endoscopy. - : Elsevier BV. - 1097-6779 .- 0016-5107. ; 55:7, s. 912-912
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Journal article (peer-reviewed)
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| 48. |
- Spada, Cristiano, et al.
(author)
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Second-generation colon capsule endoscopy compared with colonoscopy
- 2011
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In: Gastrointestinal Endoscopy. - : Elsevier BV. - 1097-6779 .- 0016-5107. ; 74:3, s. 581-589
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Journal article (peer-reviewed)abstract
- Background: Colon capsule endoscopy (CCE) represents a noninvasive technology that allows visualization of the colon without requiring sedation and air insufflation. A second-generation colon capsule endoscopy system (PillCam Colon 2) (CCE-2) was developed to increase sensitivity for colorectal polyp detection compared with the first-generation system. Objective: To assess the feasibility, accuracy, and safety of CCE-2 in a head-to-head comparison with colonoscopy. Design and Setting: Prospective, multicenter trial including 8 European sites. Patients: This study involved 117 patients (mean age 60 years). Data from 109 patients were analyzed. Intervention: CCE-2 was prospectively compared with conventional colonoscopy as the criterion standard for the detection of colorectal polyps that are >= 6 mm or masses in a cohort of patients at average or increased risk of colorectal neoplasia. Colonoscopy was independently performed within 10 hours after capsule ingestion or on the next day. Main Outcome Measurements: CCE-2 sensitivity and specificity for detecting patients with polyps >= 6 mm and >= 10 mm were assessed. Capsule-positive but colonoscopy-negative cases were counted as false positive. Capsule excretion rate, level of bowel preparation, and rate of adverse events also were assessed. Results: Per-patient CCE-2 sensitivity for polyps >= 6 mm and >= 10 mm was 84% and 88%, with specificities of 64% and 95%, respectively. All 3 invasive carcinomas were detected by CCE-2. The capsule excretion rate was 88% within 10 hours. Overall colon cleanliness for CCE-2 was adequate in 81% of patients. Limitations: Not unblinding the CCE-2 results at colonoscopy; heterogenous patient population; nonconsecutive patients. Conclusion: In this European, multicenter study, CCE-2 appeared to have a high sensitivity for the detection of clinically relevant polypoicl lesions, and it might be considered an adequate tool for colorectal imaging. (Gastrointest Enclose 201174:581-9.)
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