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Effect of Aspiration Therapy on Obesity-Related Comorbidities: Systematic Review and Meta-Analysis
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Pichamol Jirapinyo, Diogo T. H. de Moura, Laura C. Horton, Christopher C. Thompson
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Clin Endosc 2020;53(6):686-697. Published online February 28, 2020
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DOI: https://doi.org/10.5946/ce.2019.181
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 Abstract
 PDF PubReader ePub
- Background
/Aims: Aspiration therapy (AT) involves endoscopic placement of a gastrostomy tube with an external device that allows patients to drain 30% of ingested calories after meals. Its efficacy for inducing weight loss has been shown. This study aimed to assess the effect of AT on obesity-related comorbidities.
Methods
A meta-analysis of studies that assessed AT outcomes was conducted through December 2018. Primary outcomes were changes in comorbidities at 1 year following AT. Secondary outcomes were the amount of weight loss at up to 4 years and pooled serious adverse events (SAEs).
Results
Five studies with 590 patients were included. At 1 year, there were improvements in metabolic conditions: mean difference (MD) in systolic blood pressure: -7.8 (-10.7 – -4.9) mm Hg; MD in diastolic blood pressure: -5.1 (-7.0 – 3.2) mm Hg; MD in triglycerides: -15.8 (-24.0 – -7.6) mg/dL; MD in high-density lipoprotein: 3.6 (0.7–6.6) mg/dL; MD in hemoglobin A1c (HbA1c): -1.3 (-1.8 – -0.8) %; MD in aspartate transaminase: -2.7 (-4.1 – -1.3) U/L; MD in alanine transaminase: -7.5 (-9.8 – -5.2) U/L. At 1 (n=218), 2 (n=125), 3 (n=46), and 4 (n=27) years, the patients experienced 17.8%, 18.3%, 19.1%, and 18.6% total weight loss (TWL), corresponding to 46.3%, 46.2%, 48.0%, and 48.7% excess weight loss (EWL) (p<0.0001 for all). Subgroup analysis of 2 randomized controlled trials (n=225) showed that AT patients lost more weight than did controls by 11.6 (6.5–16.7) %TWL and 25.6 (16.0–35.3) %EWL and experienced greater improvement in HbA1c and alanine transaminase by 1.3 (0.8–1.8) % and 9.0 (3.9–14.0) U/L. The pooled SAE rate was 4.1%.
Conclusions
Obesity-related comorbidities significantly improved at 1 year following AT. Additionally, a subgroup of patients who continued to use AT appeared to experience significant weight loss that persisted up to at least 4 years.
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Citations
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Danse Bi, Pichamol Jirapinyo
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Fernanda Pessorrusso, Sagar V. Mehta, Shelby Sullivan
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Maria Valeria Matteo, Vincenzo Bove, Valerio Pontecorvi, Loredana Gualtieri, Giorgio Carlino, Cristiano Spada, Ivo Boškoski
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Current Gastroenterology Reports.2020;[Epub] CrossRef
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Endoscopic Ultrasound Fine-Needle Aspiration versus Fine-Needle Biopsy for Lymph Node Diagnosis: A Large Multicenter Comparative Analysis
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Diogo Turiani Hourneaux de Moura, Thomas R. McCarty, Pichamol Jirapinyo, Igor Braga Ribeiro, Galileu Ferreira Ayala Farias, Marvin Ryou, Linda S. Lee, Christopher C. Thompson
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Clin Endosc 2020;53(5):600-610. Published online December 3, 2019
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DOI: https://doi.org/10.5946/ce.2019.170
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Abstract
PDFPubReaderePub
- Background
/Aims: Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacent to the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed to evaluate the comparative efficacy and safety of FNA versus FNB for LN sampling.
Methods
This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNB for LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacy of rapid on-site evaluation (ROSE), cell-block analysis, and adverse events.
Results
A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivity and accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). The specificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was not different. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and 80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was a significant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported in either cohort.
Conclusions
Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUSFNA+ ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained a significant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusive diagnoses.
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Citations
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Mitsuru Sugimoto, Tadayuki Takagi, Rei Suzuki, Naoki Konno, Hiroyuki Asama, Yuki Sato, Hiroki Irie, Jun Nakamura, Mika Takasumi, Minami Hashimoto, Tsunetaka Kato, Yuko Hashimoto, Takuto Hikichi, Hiromasa Ohira
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Antonio Facciorusso, Marianna Arvanitakis, Stefano Francesco Crinò, Carlo Fabbri, Adele Fornelli, John Leeds, Livia Archibugi, Silvia Carrara, Jahnvi Dhar, Paraskevas Gkolfakis, Beate Haugk, Julio Iglesias Garcia, Bertrand Napoleon, Ioannis S. Papanikolao
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Amin K. Soltani, Kumar Krishnan
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Validation of a Novel Endoscopic Retrograde Cholangiopancreatography Cannulation Simulator
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Pichamol Jirapinyo, Andrew C. Thompson, Hiroyuki Aihara, Marvin Ryou, Christopher C. Thompson
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Clin Endosc 2020;53(3):346-354. Published online February 17, 2020
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DOI: https://doi.org/10.5946/ce.2019.105
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Abstract
PDF
 Supplementary MaterialPubReaderePub
- Background
/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) requires a unique skill set. Currently, there is no objective methodology to assess and train a professional to perform ERCP. This study aimed to develop and validate a novel ERCP simulator.
Methods
The simulator consists of papillae presenting different anatomy and positioned in varied locations. Deep cannulation of the pancreatic duct, followed by the bile duct, was performed. The time allotted was 5 minutes. The content validity indexes (CVIs) for realism, relevance, and representativeness were calculated. Correlation between ERCP experience and simulator score was determined.
Results
Twenty-three participants completed the simulation. The CVIs for realism were orientation of duodenoscope to papilla (1.00), angulation of papillotome to achieve cannulation (0.71), and haptic feedback during cannulation (0.80). The CVIs for relevance were use of elevator (1.00), wheels to achieve en face orientation (1.00), and papillotome for selective cannulation (1.00). Regarding CVI for representativeness, the results were as follows: basic cannulation (0.83), papilla locations (0.83), and papilla anatomies (0.80). The novice, intermediate, and experienced groups scored 6.7±8.7, 30.0±16.3, and 74.4±43.9, respectively (p<0.0001). There was a strong correlation between the ERCP experience level and the individual’s simulator score (Pearson value of 0.77, R2 of 0.60).
Conclusions
This simulator appears to be realistic, relevant, and representative of ERCP cannulation techniques. Additionally, it is effective at objectively assessing basic ERCP skills by differentiating scores based on clinical experience.
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Citations
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D.E. Benavides-Salgado, R.A. Jiménez-Castillo, J.E. Cuéllar-Monterrubio, J.O. Jáquez-Quintana, A. Garza-Galindo, C. Cortes-Hernández, H.J. Maldonado-Garza, D. García-Compeán, J.A. González-González
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Alen Maximillian Brodaric, Ngar Lok Joshua Wong, Jessica Falon, Jean Wong, Kai Cheng, Sarah Whereat, David Storey
ANZ Journal of Surgery.2023; 93(7-8): 1817. CrossRef - The use of simulators to acquire ERCP skills: a systematic review
Konstantinos Georgiou, Kiril T. Atliev, Ninos Oussi, Nikola Boyanov, Gabriel Sandblom, Lars Enochsson
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Seong Woo Jeon
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Role of Cardiac Septal Occluders in the Treatment of Gastrointestinal Fistulas: A Systematic Review
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Diogo Turiani Hourneaux De Moura, Alberto Baptista, Pichamol Jirapinyo, Eduardo Guimarães Hourneaux De Moura, Christopher Thompson
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Clin Endosc 2020;53(1):37-48. Published online July 9, 2019
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DOI: https://doi.org/10.5946/ce.2019.030
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Abstract
PDFPubReaderePub
- Treating gastrointestinal (GI) fistulas endoscopically is challenging owing to an established epithelial tract. The variety of endoscopic approaches is transforming endoscopy into a first-line therapy. However, many sessions are often required, with variable success rates. Owing to these limitations, the off-label use of cardiac septal occluders (CSOs) has been reported.
We searched for articles related to CSOs in the MEDLINE, EMBASE, Cochrane Library, and LILACS databases and gray literature. The primary outcomes included technical success, clinical success, and safety of CSOs in GI fistula management.
A total of 25,574 records were identified, and 19 studies ultimately satisfied the inclusion criteria. Technical success was achieved in all cases. Of the 22 fistulas, 77.27% had successful closure, with a mean follow-up period of 32.02 weeks. The adverse event rate was 22.72%, with no associated mortality. Univariable and multivariable regression analyses showed no significant difference in the success of closure and adverse events in relation to several variables among the subgroups.
The use of CSOs appeared to be technically feasible, effective, and safe in the treatment of GI fistulas. The satisfactory results derived from this sparse literature suggest that it can be an option in the management of GI fistulas.
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Citations
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Ayowumi A. Adekolu, Ethan M. Cohen, Sardar Momin Shah-Khan, Soban Maan, Joyce Foryoung, Ademola Ajibade, Shyam Thakkar, Shailendra Singh
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Training in Bariatric and Metabolic Endoscopic Therapies
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Pichamol Jirapinyo, Christopher C. Thompson
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Clin Endosc 2018;51(5):430-438. Published online September 30, 2018
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DOI: https://doi.org/10.5946/ce.2018.148
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Abstract
PDFPubReaderePub
- Bariatric endoscopy is an emerging subspecialty for gastroenterologists encompassing a broad array of procedures including primary endoscopic bariatric and metabolic therapies and the treatment of complications of bariatric surgery. In addition, comprehensive
understanding of lifestyle intervention and pharmacotherapy are essential to successful outcomes. This review summarizes goals and steps of training for this emerging field.
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Endoscopic Ultrasound-Guided Pancreatobiliary Endoscopy in Surgically Altered Anatomy
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Pichamol Jirapinyo, Linda S. Lee
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Clin Endosc 2016;49(6):515-529. Published online November 29, 2016
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DOI: https://doi.org/10.5946/ce.2016.144
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Abstract
PDFPubReaderePub
- Endoscopic retrograde cholangiopancreatography (ERCP) has become the mainstay of therapy for pancreatobiliary diseases. While ERCP is safe and highly effective in the general population, the procedure remains challenging or impossible in patients with surgically altered anatomy (SAA). Endoscopic ultrasound (EUS) allows transmural access to the bile or pancreatic duct (PD) prior to ductal drainage using ERCP-based techniques. Also known as endosonography-guided cholangiopancreatography (ESCP), the procedure provides multiple advantages over overtube-assisted enteroscopy ERCP or percutaneous or surgical approaches. However, the procedure should only be performed by endoscopists experienced in both EUS and ERCP and with the proper tools. In this review, various EUS-guided diagnostic and therapeutic drainage techniques in patients with SAA are examined. Detailed step-by-step procedural descriptions, technical tips, feasibility, and safety data are also discussed.
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Flávio Heuta IVANO, Bruno Jeronimo PONTE, Thais Caroline DUBIK, Victor Kenzo IVANO, Vitória Luiza Locatelli WINKELER, Antônio Katsumi KAY
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