Determining the effectiveness of bilateral intra-scapulothoracic (IS) implants versus bilateral self-expanding metallic stents (SEMS) remains a challenge.
Within a cohort of 301 patients with UMHBO, selected using a propensity score matching method, 38 patients received bilateral IS (IS group) and subsequently, SEMS implantation (SEMS group). For both groups, an analysis was conducted on technical and clinical success, adverse events (AEs), recurrent biliary obstruction (RBO), time to RBO (TRBO), overall survival (OS), and endoscopic re-intervention (ERI).
A comparative analysis revealed no meaningful differences between the groups concerning technical and clinical outcomes, adverse events (AEs), rates of remote blood oxygenation (RBO) occurrence, TRBO, or overall survival (OS). A statistically significant difference in median initial endoscopic procedure time was observed, with the IS group showing a considerably reduced time (23 minutes) compared to the control group (49 minutes, P<0.001). Within the context of the ERI procedure, 20 patients were evaluated in the IS group, and 19 in the SEMS group. Procedure time for ERI was noticeably shorter in the IS group (22 minutes) than in the control group (35 minutes), producing a statistically significant result (P=0.004). The median TRBO period following ERI, when plastic stents were inserted, showed a pronounced tendency toward prolongation in the IS group (306 days versus 56 days), yielding a statistically significant finding (P=0.068). The Cox multivariate analysis revealed a statistically significant association of the IS group with TRBO following ERI, exhibiting a hazard ratio of 0.31 (95% confidence interval 0.25-0.82) and a p-value of 0.0035.
Bilateral IS placement not only diminishes the duration of the endoscopic procedure, but also ensures consistent stent patency pre- and post-ERI stent insertion, allowing for its removal. Bilateral IS placement is frequently seen as a beneficial initial choice for UHMBO drainage.
A bilateral approach to internal sphincterotomy (IS) placement during endoscopic procedures can reduce the time required for the procedure, maintain consistent stent patency both initially and following ERI stent insertion, and permits the removal of the stent. Regarding initial UHMBO drainage, bilateral IS placement is considered a valuable technique.
In cases of malignant distal biliary obstruction causing jaundice, and following failures of both endoscopic retrograde cholangiopancreatography (ERCP) and EUS choledochoduodenostomy (EUS-CDS), endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) with lumen-apposing metal stents (LAMS) has demonstrated encouraging results in alleviating the condition.
A retrospective, multicenter analysis of all consecutive endoscopic ultrasound-guided biliary drainage (EUS-GBD) cases, employing the rescue strategy of laparoscopic access for malignant distal biliary obstruction, was conducted across 14 Italian centers between June 2015 and June 2020. Technical and clinical success served as the primary outcome measures. Adverse event (AE) rate constituted the secondary endpoint measurement.
The study population consisted of 48 patients (521% female) with a mean age of 743 ± 117 years. Among the causes of biliary strictures, several types of cancer emerged, with pancreatic adenocarcinoma being the most frequent (854%), followed by duodenal adenocarcinoma (21%), cholangiocarcinoma (42%), ampullary cancer (21%), colon cancer (42%), and metastatic breast cancer (21%). A measurement of 133 ± 28 mm was determined as the median diameter of the common bile duct. A transgastric approach was utilized for LAMS insertion in 583% of the studied cases; conversely, a transduodenal route was chosen for 417% of the cases. The technical aspect of the procedure saw 100% success, yet the clinical results were significantly more impressive, yielding 813% success, and a mean total bilirubin reduction of 665% in just two weeks. Procedure times averaged 264 minutes, with a mean hospital stay of 92.82 days. In a group of 48 patients, 5 (10.4%) experienced adverse events. Three of these events were intraprocedural, while 2 developed after more than 15 days, classified as delayed. Based on the criteria of the American Society for Gastrointestinal Endoscopy (ASGE), two cases were classified as mild, and three were categorized as moderate, specifically two cases involving buried LAMS. Label-free immunosensor Following a median period of 122 days, the follow-up was completed.
Our study indicates that EUS-GBD with LAMS employed as a salvage treatment for malignant distal biliary obstruction proves to be a worthwhile option, achieving good technical and clinical success rates, while maintaining a low adverse event rate. As far as we know, this is the most extensive study exploring the use of this method. NCT03903523 represents the registration number for the clinical trial.
Employing EUS-GBD, coupled with LAMS, as a rescue procedure for patients with malignant distal biliary obstruction, our study reveals a noteworthy approach, characterized by robust technical and clinical success rates, and a manageable rate of adverse events. In our estimation, this study represents the most substantial investigation concerning the use of this procedure. A clinical trial, identified by its registration number, NCT03903523, is underway.
Gastric cancer is commonly seen in individuals with pre-existing chronic gastritis. Utilizing the Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) system for risk assessment, elevated gastric cancer (GC) risk was observed in stage III and IV patients, characterized by the degree of intestinal metaplasia (IM). The OLGIM system, though practical, necessitates profound expertise to formulate precise IM evaluations. Although whole-slide imaging is now a standard procedure, artificial intelligence systems in pathology are predominantly targeted at recognizing neoplastic lesions.
Image files were generated from the hematoxylin and eosin-stained slides. Each gastric biopsy tissue image was categorized and assigned an IM score. The IM scale was as follows: 0 (no IM), 1 (mild IM), 2 (moderate IM), and 3 (severe IM). A total of 5753 images were completed and readied for deployment. The classification process leveraged the deep convolutional neural network (DCNN) architecture, ResNet50.
ResNet50's classification of images, differentiating between those with and without IM, demonstrated a sensitivity score of 977% and a specificity score of 946%. ResNet50's analysis found that 18% of cases featuring stage III or IV criteria from the OLGIM system were characterized by IM scores of 2 and 3. Complete pathologic response The sensitivity and specificity, when classifying IM into scores 0, 1, and 2, 3, were 98.5% and 94.9%, respectively. The IM scores assigned by the AI system and the pathologists diverged on a mere 438 (76%) of all images. ResNet50's analysis suggests a tendency to miss small IM foci, yet identify minimal IM areas that pathologists overlooked during their review process.
This AI system's potential to evaluate the risk of gastric cancer with accuracy, reliability, and repeatability, according to our study, is supported by a worldwide standardization.
Our study revealed that this AI system will contribute to evaluating gastric cancer risk globally, ensuring accuracy, reliability, and consistent results.
Endoscopic ultrasound (EUS)-guided biliary drainage (BD) has been scrutinized in numerous meta-analyses regarding technical and clinical outcomes, but meta-analyses concentrating on adverse events (AEs) are comparatively infrequent. This meta-analytic study aimed to assess the adverse events associated with different types of endoscopic ultrasound-guided biliary drainage (EUS-BD).
Examining EUS-BD outcomes, a literature search across MEDLINE, Embase, and Scopus databases was executed, focusing on publications from 2005 to September 2022. Key results comprised the rate of all adverse events, serious adverse events, deaths connected to the procedure, and the necessity for repeat procedures. learn more Event rates were aggregated using a random-effects modeling approach.
The final analysis incorporated a sample of 7887 participants, drawn from 155 individual studies. The pooled success rate for EUS-BD procedures was 95% (95% confidence interval [CI] 94.1-95.9), and the incidence of adverse events was 137% (95% CI 123-150). Amongst the initial adverse events (AEs), bile leakage demonstrated the highest frequency, surpassing cholangitis, which was less prevalent. A pooled incidence analysis revealed 22% (95% confidence interval [CI] 18-27%) for bile leakage, and 10% (95% confidence interval [CI] 08-13%) for cholangitis. Major adverse events and procedure-related mortality following EUS-BD exhibited pooled incidences of 0.6% (95% confidence interval 0.3%–0.9%) and 0.1% (95% confidence interval 0.0%–0.4%), respectively. The combined occurrence of delayed migration and stent occlusion was 17% (95% CI 11-23), and 110% (95% CI 93-128), respectively. The reintervention rate (for stent migration or occlusion) after EUS-BD, when pooled, reached 162% (95% confidence interval 140 – 183; I).
= 775%).
Despite the substantial clinical success of EUS-BD, a fraction, equivalent to one-seventh of the cases, may still experience adverse events. Yet, the reported rate of major adverse events and mortality stays well below 1%, giving cause for optimism.
Though clinically successful, EUS-BD can be accompanied by adverse events, affecting roughly one-seventh of the patients subjected to the treatment. Despite this, the rate of major adverse events and mortality is less than 1%, which is reassuring.
In cases of HER-2 (ErbB2)-positive breast cancer, Trastuzumab (TRZ) serves as a chemotherapeutic agent in the initial phase of treatment. Due to its detrimental effect on the heart, leading to TRZ-induced cardiotoxicity (TIC), the clinical utility of this substance remains restricted. Still, the specific molecular machinery that initiates TIC formation is not completely elucidated. Ferroptosis is a consequence of the orchestrated participation of iron and lipid metabolism, as well as redox reactions. Our findings reveal ferroptosis's impact on mitochondrial function within tumor-initiating cells, observed both within the living body and within laboratory cultures.