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Jansen Frantzen posted an update 8 months, 1 week ago
BACKGROUND Introduction of the full-thickness resection device (FTRD) has allowed endoscopic resection of difficult lesions such as those with deep wall origin/infiltration or those located in difficult anatomic locations. The aim of this study is to assess the outcomes of the FTRD among its early users in the USA. METHODS Patients who underwent endoscopic full-thickness resection (EFTR) for lower gastrointestinal tract lesions using the FTRD at 26 US tertiary care centers between 10/2017 and 12/2018 were included. Primary outcome was R0 resection rate. Secondary outcomes included rate of technical success (en bloc resection), achievement of histologic full-thickness resection (FTR), and adverse events (AE). RESULTS A total of 95 patients (mean age 65.5 ± 12.6 year, 38.9% F) were included. The most common indication, for use of FTRD, was resection of difficult adenomas (non-lifting, recurrent, residual, or involving appendiceal orifice/diverticular opening) (66.3%), followed by adenocarcinomas (22.1%), and subepithelial tumors (SET) (11.6%). Lesions were located in the proximal colon (61.1%), distal colon (18.9%), or rectum (20%). Mean lesion diameter was 15.5 ± 6.4 mm and 61.1% had a prior resection attempt. The mean total procedure time was 59.7 ± 31.8 min. R0 resection was achieved in 82.7% while technical success was achieved in 84.2%. Histologically FTR was demonstrated in 88.1% of patients. There were five clinical AE (5.3%) with 2 (2.1%) requiring surgical intervention. CONCLUSIONS Results from this first US multicenter study suggest that EFTR with the FTRD is a technically feasible, safe, and effective technique for resecting difficult colonic lesions.BACKGROUND Pancreatic enucleation (PE) is a viable option for the removal of non-malignant pancreatic masses leading to complete preservation of organ function. Nevertheless, PE is associated with substantial rates of post-operative pancreatic fistula (POPF), particularly when the mass is close to the main pancreatic duct (MPD). Preoperative stenting of the MPD may prevent its injury when performing PE. This paper describes a novel technique of “deep” PE preceded by endoscopic stenting of the MPD. METHODS From January 2017 to May 2019, patients with small pancreatic neuroendocrine tumors proximal to the MPD were candidates for PE with previous stenting of the MPD at the University of Verona, Italy, and at the UCLA Medical Center, Los Angeles, California. The endoscopic stenting was scheduled either the day before or 3 weeks before surgery, depending on the participating institute. RESULTS Ten patients were included in this pilot study. The endoscopic procedure was successful and well tolerated in all cases. Open, laparoscopic and robotic PE were performed. Seven patients had surgical complications. Among these, six developed a post-operative pancreatic fistula (POPF), but neither grade C fistulas nor disruptions of the MPD were detected. At pathology, a low grade pancreatic neuroendocrine tumor was confirmed in all cases. CONCLUSION In the setting of high-volume centers, this procedure is safe, and it is associated with acceptable short-term surgical morbidity. The preoperative stenting of the MPD might extend the surgical indications for PE.BACKGROUND AND AIM Surgical management by a bilioenteric anastomosis is the standard for the repair of post-cholecystectomy benign biliary strictures (BBS). This is traditionally done as an open operation. There are a few reports describing the procedure by a laparoscopic technique. The aim of the present study was to describe our experience of laparoscopic bilio-enteric anastomosis in the management of post-cholecystectomy BBS and compare the outcomes with our patients operated by the open approach. METHODS Retrospective analysis of prospective data of post-cholecystectomy BBS patients treated by laparoscopic bilio-enteric anastomosis. The outcomes were compared with patients who underwent an open repair. RESULTS Between January 2016 and February 2019, 63 patients underwent surgery for post-cholecystectomy BBS. Twenty-nine patients who underwent laparoscopic bilio-enteric anastomosis (LRYHJ-13, LHD-16) were compared with 34 patie 0.034). The other parameters like the mean intraoperative blood loss, time to initiate oral diet, duration of postoperative hospital stay, and incidence of postoperative bile leak were similar. Patients undergoing open repair had a median follow-up of 26 months with two developing anastomotic stenosis and those undergoing laparoscopic repair had a median follow-up for 9 months with one developing anastomotic stenosis. Venetoclax in vitro CONCLUSION Laparoscopic surgery for post-cholecystectomy BBS with an LRYHJ or LHD is feasible and safe and compares favourably with the open approach.PURPOSE To systematically review evidence regarding the benefits of Internet-based psycho-educational interventions among cancer patients. METHODS We performed a systematic review with meta-analysis and qualitative evidence synthesis. Systematic searches for published studies in English or Chinese identified eligible randomized and clinical controlled trials. The following databases were searched Medline, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), Proquest Digital Dissertations, Foreign Medical Retrieval System, China National Knowledge Infrastructure, China Science and Technology Journal Database, China Wanfang Database, and Taiwanese Airiti Library. We also searched the gray literature and reviewed reference lists from relevant articles. Studies were scored for quality using the Cochrane Risk of Bias Tool. RESULTS Seven eligible studies (1220 participants) were identified that used three intervention tools website programs (n = 5), e-mail counseling (n = 1), and a single-session psycho-educational intervention (n = 1). The quality of all studies was moderate. The meta-analysis showed that Internet-based psycho-educational interventions had a significant effect on decreasing depression (standardized mean difference (SMD) - 0.58, 95% confidence interval (CI) (- 1.12, - 0.03), p = 0.04) and fatigue (mean difference (MD) - 9.83, 95% CI (- 14.63, - 5.03), p less then 0.01). However, there was no evidence for effects on distress (SMD - 1.03, 95% CI (- 2.63, 0.57), p = 0.21) or quality of life (MD 1.10, 95% CI (- 4.42, 6.63), p = 0.70). CONCLUSION Internet-based psycho-educational interventions reduce fatigue and depression in cancer patients. More rigorous studies with larger samples and long-term follow-up are warranted to investigate the effects of these interventions on cancer patient quality of life and other psychosocial outcomes.