BACKGROUND Metabolic syndrome is a multifactorial disease,and the gut microbiota may play a role in its pathogenesis.Obesity,especially abdominal obesity,is associated with insulin resistance,often increasing the risk...BACKGROUND Metabolic syndrome is a multifactorial disease,and the gut microbiota may play a role in its pathogenesis.Obesity,especially abdominal obesity,is associated with insulin resistance,often increasing the risk of type two diabetes mellitus,vascular endothelial dysfunction,an abnormal lipid profile,hypertension,and vascular inflammation,all of which promote the development of atherosclerotic cardiovascular disease.AIM To evaluate the outcomes of fecal microbiota transplantation(FMT)in patients with metabolic syndrome.METHODS This was a randomized,single-blind placebo-controlled trial comparing FMT and a sham procedure in patients with metabolic syndrome.We selected 32 female patients,who were divided into eight groups of four patients each.All of the patients were submitted to upper gastrointestinal endoscopy.In each group,two patients were randomly allocated to undergo FMT,and the other two patients received saline infusion.The patients were followed for one year after the procedures,during which time anthropometric,bioimpedance,and biochemical data were collected.The patients also had periodic consultations with a nutritionist and an endocrinologist.The primary end point was a change in the gut microbiota.RESULTS There was evidence of a postprocedural change in microbiota composition in the patients who underwent FMT in relation to that observed in those who underwent the sham procedure.However,we found no difference between the two groups in terms of the clinical parameters evaluated.CONCLUSION There were no significant differences in biochemical or anthropometric parameters,between the two groups evaluated.Nevertheless,there were significant postprocedural differences in the microbiota composition between the placebo group.To date,clinical outcomes related to FMT remain uncertain.展开更多
BACKGROUND Biliary drainage,either by the stent-in-stent(SIS)or side-by-side(SBS)technique,is often required when treating a malignant hilar biliary obstruction(MHBO).Both methods differ from each other and have disti...BACKGROUND Biliary drainage,either by the stent-in-stent(SIS)or side-by-side(SBS)technique,is often required when treating a malignant hilar biliary obstruction(MHBO).Both methods differ from each other and have distinct advantages.AIM To compare both techniques regarding their efficacy and safety in achieving drainage of MHBO.METHODS A comprehensive search of multiple electronic databases(MEDLINE,Embase,LILACS,BIREME,Cochrane)was conducted and grey literature from their inception until December 2020 with no restrictions regarding the year of publication or language,since there was at least an abstract in English.The included studies compared SIS and SBS techniques through endoscopic retrograde cholangiopancreatography.Outcomes analyzed included technical and clinical success,early and late adverse events(AEs),stent patency,reintervention,and procedure-related mortality.RESULTS Four cohort studies and one randomized controlled trial evaluating a total of 250 patients(127 in the SIS group and 123 in the SBS group)were included in this study.There were no statistically significant differences between the two groups concerning the evaluated outcomes,except for stent patency,which was higher in the SIS compared with the SBS technique[mean difference(d)=33.31;95%confidence interval:9.73 to 56.90,I2=45%,P=0.006].CONCLUSION The SIS method showed superior stent patency when compared to SBS for achieving bilateral drainage in MHBO.Both techniques are equivalent in terms of technical success,clinical success,rates of both early and late AEs,reintervention,and procedure-related mortality.展开更多
BACKGROUND Per-oral endoscopic myotomy(POEM)is safe and effective for the treatment of achalasia.There is limited data on performance of POEM in patients with altered upper gastrointestinal anatomy,especially after ba...BACKGROUND Per-oral endoscopic myotomy(POEM)is safe and effective for the treatment of achalasia.There is limited data on performance of POEM in patients with altered upper gastrointestinal anatomy,especially after bariatric surgery.Outcomes in patients with prior sleeve gastrectomy have not been reported.AIM To assess the efficacy and safety of POEM in patients with prior bariatric surgery.METHODS A prospective POEM database was reviewed from 3/2017-5/2020 to identify patients who underwent POEM after prior bariatric surgery.Efficacy was assessed by technical success(defined as the ability to successfully complete the procedure)and clinical success[decrease in Eckardt score(ES)to≤3 post procedure].Safety was evaluated by recording adverse events.RESULTS Six patients(50%male,mean age 48 years)with a history of prior bariatric surgery who underwent POEM were included.Three had prior sleeve gastrectomy(SG)and three prior Roux-en-Y gastric bypass(RYGB).Four patients had achalasia subtype II and 2 had type I.Most(4)patients had undergone previous achalasia therapy.Technical success was 100%.Clinical success was achieved in 4(67%)patients at mean follow-up of 21 mo.In one of the clinical failures,EndoFLIP evaluation demonstrated adequate treatment and candida esophagitis was noted as the likely cause of dysphagia.There were no major adverse events.CONCLUSION POEM is technically feasible after both RYGB and SG and offers an effective treatment for this rare group of patients where surgical options for achalasia are limited.展开更多
文摘BACKGROUND Metabolic syndrome is a multifactorial disease,and the gut microbiota may play a role in its pathogenesis.Obesity,especially abdominal obesity,is associated with insulin resistance,often increasing the risk of type two diabetes mellitus,vascular endothelial dysfunction,an abnormal lipid profile,hypertension,and vascular inflammation,all of which promote the development of atherosclerotic cardiovascular disease.AIM To evaluate the outcomes of fecal microbiota transplantation(FMT)in patients with metabolic syndrome.METHODS This was a randomized,single-blind placebo-controlled trial comparing FMT and a sham procedure in patients with metabolic syndrome.We selected 32 female patients,who were divided into eight groups of four patients each.All of the patients were submitted to upper gastrointestinal endoscopy.In each group,two patients were randomly allocated to undergo FMT,and the other two patients received saline infusion.The patients were followed for one year after the procedures,during which time anthropometric,bioimpedance,and biochemical data were collected.The patients also had periodic consultations with a nutritionist and an endocrinologist.The primary end point was a change in the gut microbiota.RESULTS There was evidence of a postprocedural change in microbiota composition in the patients who underwent FMT in relation to that observed in those who underwent the sham procedure.However,we found no difference between the two groups in terms of the clinical parameters evaluated.CONCLUSION There were no significant differences in biochemical or anthropometric parameters,between the two groups evaluated.Nevertheless,there were significant postprocedural differences in the microbiota composition between the placebo group.To date,clinical outcomes related to FMT remain uncertain.
文摘BACKGROUND Biliary drainage,either by the stent-in-stent(SIS)or side-by-side(SBS)technique,is often required when treating a malignant hilar biliary obstruction(MHBO).Both methods differ from each other and have distinct advantages.AIM To compare both techniques regarding their efficacy and safety in achieving drainage of MHBO.METHODS A comprehensive search of multiple electronic databases(MEDLINE,Embase,LILACS,BIREME,Cochrane)was conducted and grey literature from their inception until December 2020 with no restrictions regarding the year of publication or language,since there was at least an abstract in English.The included studies compared SIS and SBS techniques through endoscopic retrograde cholangiopancreatography.Outcomes analyzed included technical and clinical success,early and late adverse events(AEs),stent patency,reintervention,and procedure-related mortality.RESULTS Four cohort studies and one randomized controlled trial evaluating a total of 250 patients(127 in the SIS group and 123 in the SBS group)were included in this study.There were no statistically significant differences between the two groups concerning the evaluated outcomes,except for stent patency,which was higher in the SIS compared with the SBS technique[mean difference(d)=33.31;95%confidence interval:9.73 to 56.90,I2=45%,P=0.006].CONCLUSION The SIS method showed superior stent patency when compared to SBS for achieving bilateral drainage in MHBO.Both techniques are equivalent in terms of technical success,clinical success,rates of both early and late AEs,reintervention,and procedure-related mortality.
文摘BACKGROUND Per-oral endoscopic myotomy(POEM)is safe and effective for the treatment of achalasia.There is limited data on performance of POEM in patients with altered upper gastrointestinal anatomy,especially after bariatric surgery.Outcomes in patients with prior sleeve gastrectomy have not been reported.AIM To assess the efficacy and safety of POEM in patients with prior bariatric surgery.METHODS A prospective POEM database was reviewed from 3/2017-5/2020 to identify patients who underwent POEM after prior bariatric surgery.Efficacy was assessed by technical success(defined as the ability to successfully complete the procedure)and clinical success[decrease in Eckardt score(ES)to≤3 post procedure].Safety was evaluated by recording adverse events.RESULTS Six patients(50%male,mean age 48 years)with a history of prior bariatric surgery who underwent POEM were included.Three had prior sleeve gastrectomy(SG)and three prior Roux-en-Y gastric bypass(RYGB).Four patients had achalasia subtype II and 2 had type I.Most(4)patients had undergone previous achalasia therapy.Technical success was 100%.Clinical success was achieved in 4(67%)patients at mean follow-up of 21 mo.In one of the clinical failures,EndoFLIP evaluation demonstrated adequate treatment and candida esophagitis was noted as the likely cause of dysphagia.There were no major adverse events.CONCLUSION POEM is technically feasible after both RYGB and SG and offers an effective treatment for this rare group of patients where surgical options for achalasia are limited.
