RESUMEN
OBJECTIVES: Colorectal endoscopic submucosal dissection (ESD) is a technically complex procedure. The scissor knife mechanism may potentially provide easier and safer colorectal ESD. The aim of this meta-analysis is to evaluate the efficacy and safety of scissor-assisted vs. conventional ESD for colorectal lesions. METHODS: A search strategy was conducted in MEDLINE, Embase, and Lilacs databases from January 1990 to November 2023 according to PRISMA guidelines. Fixed and random-effects models were used for statistical analysis. Heterogeneity was assessed using I2 test. Risk of bias was assessed using the ROBINS-I and RoB-2 tools. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS: A total of five studies (three retrospective and two randomized controlled trials, including a total of 1575 colorectal ESD) were selected. The intraoperative perforation rate was statistically lower (risk difference [RD] -0.02; 95% confidence interval [CI] -0.04 to -0.01; P = 0.001; I2 = 0%) and the self-completion rate was statistically higher (RD 0.14; 95% CI 0.06, 0.23; P = 0.0006; I2 = 0%) in the scissor-assisted group compared with the conventional ESD group. There was no statistical difference in R0 resection rate, en bloc resection rate, mean procedure time, or delayed bleeding rate between the groups. CONCLUSION: Scissor knife-assisted ESD is as effective as conventional knife-assisted ESD for colorectal lesions with lower intraoperative perforation rate and a higher self-completion rate.
RESUMEN
The intravenous contrast (IV) allows for improving the diagnostic accuracy of echoendoscopy for many pathologic conditions. IV contrast provides a non-invasive method that through the use of real-time enhancement patterns (hypo, iso, and hypercaptation), a highly accurate histological diagnosis can be made by characterizing the microvasculature of an organ or a lesion. However, the lack of availability of IV contrast limited its use in our setting. We reported three cases of endoscopic ultrasound with IV contrast performed in the pancreatic department of National Hospital Eduardo Rebagliati Martins in Lima, Peru. We described the effectiveness of IV contrast in the diagnosis and the management of solid and cystic lesions in the pancreas.
Asunto(s)
Medios de Contraste/administración & dosificación , Endosonografía/métodos , Páncreas/diagnóstico por imagen , Enfermedades Pancreáticas/diagnóstico por imagen , Administración Intravenosa , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
RESUMEN El empleo del contraste endovenoso permite aumentar la capacidad diagnostica de la ecoendoscopía en muchas condiciones patológicas de forma no invasiva, mediante la evaluación de patrones de realce en tiempo real (hipo, iso e hipercaptación), permitiendo a su vez definir diagnósticos diferenciales o predecir diagnósticos histológicos con alta precisión por medio de la caracterización de la vascularidad o microvasculatura de un órgano o lesión. Sin embargo, su empleo en nuestro medio está limitado por no contar con estos medios de contraste. Reportamos tres casos de ecoendoscopía contrastada realizada en patología pancreática realizada en nuestro hospital, en el que se describe la utilidad en el diagnóstico y manejo de lesiones sólidas y quísticas del páncreas.
ABSTRACT The intravenous contrast (IV) allows for improving the diagnostic accuracy of echoendoscopy for many pathologic conditions. IV contrast provides a non-invasive method that through the use of real-time enhancement patterns (hypo, iso, and hypercaptation), a highly accurate histological diagnosis can be made by characterizing the microvasculature of an organ or a lesion. However, the lack of availability of IV contrast limited its use in our setting. We reported three cases of endoscopic ultrasound with IV contrast performed in the pancreatic department of National Hospital Eduardo Rebagliati Martins in Lima, Peru. We described the effectiveness of IV contrast in the diagnosis and the management of solid and cystic lesions in the pancreas.