This systematic review aimed to assess the efficacy of the current approach to tissue traction during the endoscopic submucosal dissection (ESD) of superficial esophageal cancer, early gastric cancer, and colorectal neoplasms. We performed a systematic electronic literature search of articles published in PubMed and selected comparative studies to investigate the treatment outcomes of tractionassisted versus conventional ESD. Using the keywords, we retrieved 381 articles, including five eligible articles on the esophagus, 13 on the stomach, and 12 on the colorectum. A total of seven randomized controlled trials and 23 retrospective studies were identified. Clip line traction and submucosal tunneling were effective in reducing the procedural time during esophageal ESD. The efficacy of traction methods in gastric ESD varied in terms of the devices and strategies used depending on the lesion location and degree of submucosal fibrosis. Several prospective and retrospective studies utilized traction devices without the need to reinsert the colonoscope. When pocket creation is included, the traction devices and methods effectively shorten the procedural time during colorectal ESD. Conclusions: Although the efficacy is dependent on the organ and tumor locations, several traction techniques have been demonstrated to be efficacious in facilitating ESD by maintaining satisfactory traction during dissection. (Gut Liver,
Endocytoscopy (EC) is now one of the valuable technologies in diagnosing colorectal tumors.Providing ultra-high-resolution white light images (520×), endocytoscopy attains the so called virtual histology or optical biopsy, making it a promising tool to diagnose colorectal lesions. Recent studies about artificial intelligence (AI) or computer aided diagnosis (CAD) are also increasingly reported. We investigate the current application of endocytoscopy, as well as the benefit of AI and CAD. Furthermore, we performed a meta-analysis comparing the diagnostic performance of endocytoscopy and magnified chromoendoscopy.In conclusion, this systematic review and meta-analysis supports the recent finding indicating the higher diagnostic performance of endocytoscope in the depth assessment of colorectal neoplasms.
Impact of endoscopic submucosal dissection of an anal squamous intraepithelial lesion with indistinct border ▶ Fig. 1 Endoscopic images showing whitish nodules and elevated papillary lesions of various sizes in the anal transitional zone: a white light; b chromoendoscopy; c narrow-band imaging (NBI).
VIEKIRA PAK (ritonavir-boosted paritaprevir/ombitasvir and dasabuvir) is an approved treatment for compensated patients with genotype 1 (GT1) chronic hepatitis C virus (HCV) infection. This oral regimen has minimal adverse effects and is well tolerated. Cure rates are 97% in patients infected with HCV GT 1a and 99% in those with HCV GT 1b. We report the first case of life-threatening allergic pneumonitis associated with VIEKIRA PAK. This unexpected serious adverse event occurred in a 68-year-old Chinese female with genotype 1b chronic hepatitis C and Child-Pugh A cirrhosis. One week into treatment with VIEKIRA PAK without ribavirin, she was admitted to hospital with respiratory distress and acute kidney injury requiring intensive care input. She was initially diagnosed with community acquired pneumonia and improved promptly with intravenous antibiotics and supported care. No bacterial or viral pathogens were cultured. Following complete recovery, she recommenced VIEKIRA PAK but represented 5 days later with more rapidly progressive respiratory failure, requiring intubation and ventilation, inotropic support, and haemodialysis. The final diagnosis was drug induced pneumonitis.
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