OBJECTIVES:Small intestinal bacterial overgrowth (SIBO) can complicate chronic pancreatitis (CP) and interfere with management. Its predisposing factors in CP and treatment response are unknown. In this review, we evaluated factors affecting disease burden.METHODS:A computerized search of PubMed and EMBASE databases from inception through May 2019 was done for studies correlating SIBO with CP. Studies were screened, and relevant data were extracted and analyzed. Pooled prevalence, odds ratio (OR), and meta-regression were performed using the random effects model as classically described by Borenstein et al. (2009). SIBO's relation to diabetes mellitus (DM), pancreatic exocrine insufficiency (PEI), narcotic use, and proton-pump inhibitor use was investigated. Treatment response was pooled across studies. P value < 0.05 was considered significant.RESULTS:In 13 studies containing 518 patients with CP, SIBO prevalence was 38.6% (95% confidence interval [CI] 25.5–53.5). OR for SIBO in CP vs controls was 5.58 (95% CI 2.26–13.75). Meta-regression showed that PEI and the diagnostic test used were able to explain 54% and 43% of the variance in SIBO prevalence across studies, respectively. DM and PEI were associated with increased SIBO in CP with OR (2.1, 95% CI 1.2–3.5) and OR (2.5, 95% CI 1.3–4.8), respectively. Symptomatic improvement was reported in 76% of patients after SIBO treatment.DISCUSSION:SIBO complicates 38% of CP with OR of 5.58 indicating a predisposition for this condition. PEI correlates with SIBO in CP and might play a role in pathophysiology. DM and PEI are associated with increased SIBO in CP. Treatment of SIBO may lead to symptomatic improvement.
Objective The Covid‐19 pandemic led to challenging discussions between oncology clinicians and patients regarding additional risks posed by SARS‐CoV‐2 infection whilst receiving systemic anti‐cancer therapies (SACT). We assess the potential factors affecting discontinuation of adjuvant early breast cancer treatment during the pandemic. Methods Data were collected on all patients with early breast cancer undergoing adjuvant SACT, between 16 March and 17 April 2020 at a single UK cancer centre. Univariate binary logistic regression analysis was performed on variables including age, recurrence risk, Index of Multiple Deprivation decile, presence of physical comorbidities, modality of treatment (neoadjuvant or adjuvant), type of treatment (cytotoxic chemotherapy or monoclonal antibodies), percentage of cycles completed and availability of alternative treatments, with a binary dependent variable on treatment discontinuation. Results Sixty‐two patients with early breast cancer were identified: 18 receiving neoadjuvant and 44 adjuvant therapies. Median age was 57.5 years (range 31–75 years). Age ( P = 0.02), percentage of treatment cycles completed ( P = 0.014) and presence of alternative treatment options ( P = 0.019) were significant factors for SACT discontinuation during the height of the Covid‐19 pandemic. Conclusion Factors affecting patients' decisions to discontinue SACT for early breast cancer during the Covid‐19 pandemic were elucidated, which may help identify patients requiring additional support.
Background: Since endoscopioc ultrasound-guided fine-needle aspiration (EUS-FNA) has achieved a pivotal role in the diagnostic evaluation of pancreatic masses, recent new dedicated devices to acquire histologic core tissue were introduced. Although a new domestic needle (ClearTip TM , Finemedix, Daegu, South Korea) was developed and has been used in clinical practice, a comparative study to other fineneedle biopsy (FNB) needles was not established. Methods: As a prospective randomized multicenter trial, patients with pancreatic solid lesions who referred for endoscopic ultrasound-guided tissue sampling (EUS-TS) were enrolled. During EUS-TS, each one pass of a new needle (22-gauge ClearTip) and 22G ProCore needle (Cook Medical Inc., Winston-Salem, NC, USA) was randomly performed to obtain a core specimen for same lesions. Technical evaluations such as easy of puncture, visibility of needle in ultrasound image, easy of to-and-fro motion, and angulation of needle after puncture were compared between two needles. To compare the specimen adequacy obtained from each pass of two needles, gross finding for core tissue, arbitrary histologic score, and diagnostic accuracy based on diagnostic standard was evaluated. Results: In total, 103 patients (59 men, 42 women, median age 67 years: range 41-92) were enrolled between July and November 2019. Among them, two patients were excluded due each case of nonpancreatic lesion and loss of follow up. In the technical evaluation, visibility of needle in ultrasound image was statistically better in ClearTip group than ProCore group (99.0% vs. 92.1%, PZ0.035). There were no differences between two groups in terms of presence of gross core tissue (60.4% vs. 55.4%, PZ0.763), histologic class for malignancy (PZ0.497), and microscopic scores (PZ0.665). The overall diagnostic accuracy for malignancy was 86.1% with no difference between two groups (75.2% vs. 69.3%, PZ0.432). Adverse events were occurred in 8 (7.9%) patients including post-puncture bleeding (3), abdominal pain (2), fever (1), and cerebral infarction (1). Conclusions: In our study, ClearTip needle revealed a comparative results to Pro-Core needle in technical assessment and diagnostic performances. Further comparative study is needed for non-pancreatic lesions to validate the efficacy of a new needle.
e16729 Background: Pancreatic adenocarcinoma (PADC) remains one of the most fatal malignancies with poor outcomes and prognosis. Several risk factors have been associated with its development such as smoking, age, obesity, chronic pancreatitis, diabetes mellitus and a family history of PADC. Furthermore, recent pathologic studies demonstrated that fatty infiltration of the pancreas (FP) is positively correlated with PADC development. We sought to systematically review the literature and perform the first meta-analysis to study the risk of PADC among patients with FP. Methods: We conducted a systematic search of the Pubmed, EMBASE, and Cochrane databases from inception through November-2019 for studies correlating FP with PADC. Relevant data was extracted and analyzed using comprehensive meta-analysis software. Random-effects model was used for all variables. Heterogeneity was assessed using the I2 measure and Cochrane Q-statistic. Publication bias was assessed using Egger’s test. Meta regression models accounting for independent variables such as age, sex, smoking, family history of PADC, chronic pancreatitis and method of FP diagnosis were constructed to explain heterogeneity. Results: Five observational case-control studies published between 2014 and 2019 including a total of 761 patients (320 PADC patients and 441 controls) were included. FP was associated with increased PADC with an OR 4.6 (CI 2.4-8.9) compared to controls with a considerable heterogeneity (I2= 69%). Meta regression analysis accounting for modality used to diagnose FP was able to explain 100% of the noted heterogeneity. Conclusions: While we noted FP to be significantly associated with increased PADC, heterogeneity in FP diagnostic approach resulted in significant inter-study variation. A consensus on a clear definition of FP with a standardized diagnostic approach is needed to better appraise literature on this emerging disease entity. Further prospective studies are needed to validate our results and explore the possible role for PADC screening in FP in addition to known factors such as family history and new-onset diabetes mellitus.
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