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ABSTRACT: The prognosis of esophageal cancer (EC) depends on the depth of tumor invasion and lymph node metastasis. EC limited to the mucosa (T1a) can be treated effectively with minimally invasive endoscopic therapy, whereas submucosal (T1b) EC carries relatively high risk of lymph node metastasis and requires surgical resection.
To determine the diagnostic accuracy of EUS in differentiating T1a EC from T1b EC.
We performed a comprehensive search of MEDLINE, SCOPUS, Cochrane, and CINAHL Plus databases to identify studies in which results of EUS-based staging of EC were compared with the results of histopathology of EMR or surgically resected esophageal lesions. DerSimonian-Laird random-effects model was used to estimate the pooled sensitivity, specificity, and likelihood ratio, and a summary receiver operating characteristic (SROC) curve was created.
Meta-analysis of 19 international studies.
Total of 1019 patients with superficial EC (SEC).
EUS and EMR or surgical resection of SEC.
Sensitivity and specificity of EUS in accurately staging SEC.
The pooled sensitivity, specificity, and positive and negative likelihood ratio of EUS for T1a staging were 0.85 (95% CI, 0.82-0.88), 0.87 (95% CI, 0.84-0.90), 6.62 (95% CI, 3.61-12.12), and 0.20 (95% CI, 0.14-0.30), respectively. For T1b staging, these results were 0.86 (95% CI, 0.82-0.89), 0.86 (95% CI, 0.83-0.89), 5.13 (95% CI, 3.36-7.82), and 0.17 (95% CI, 0.09-0.30), respectively. The area under the curve was at least 0.93 for both mucosal and submucosal lesions.
Heterogeneity was present among the studies.
Overall EUS has good accuracy (area under the curve ≥0.93) in staging SECs. Heterogeneity among the included studies suggests that multiple factors including the location and type of lesion, method and frequency of EUS probe, and the experience of the endosonographer can affect the diagnostic accuracy of EUS.
Gastrointestinal endoscopy 11/2011; 75(2):242-53. · 6.71 Impact Factor
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ABSTRACT: Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure.
A systematic review was conducted (1978-2008). A summary risk estimate was calculated using a random-effects meta-analysis model.
Twenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP-site injections were the most commonly reported conservative treatments. Prosthetic diameter (p = .076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported.
The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management.
Head & Neck 01/2011; 33(1):20-30. · 2.40 Impact Factor
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ABSTRACT: Background
Enlargement of the tracheoesophageal puncture (TEP) is a challenging complication after laryngectomy with TEP. We sought to estimate the rate of enlarged puncture, associated pneumonia rates, potential risk factors, and conservative treatments excluding complete surgical TEP closure.MethodsA systematic review was conducted (1978–2008). A summary risk estimate was calculated using a random-effects meta-analysis model.ResultsTwenty-seven peer-reviewed manuscripts were included. The rate of enlarged puncture and/or leakage around the prosthesis was reported in 23 articles (range, 1% to 29%; summary risk estimate, 7.2%; 95% confidence interval [CI], 4.8% to 9.6%). Temporary removal of the prosthesis and TEP-site injections were the most commonly reported conservative treatments. Prosthetic diameter (p = .076) and timing of TEP (p = .297) were analyzed as risk factors; however, radiotherapy variables were inconsistently reported.Conclusion
The overall risk of enlarged puncture seems relatively low, but it remains a rehabilitative challenge. Future research should clearly establish risk factors for enlarged puncture and optimal conservative management. © 2010 Wiley Periodicals, Inc. Head Neck, 2011
Head & Neck 12/2010; 33(1):20 - 30. · 2.40 Impact Factor
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ABSTRACT: To provide histologic correlation of endoscopic ultrasound (EUS) findings believed to represent chronic pancreatitis (CP).
Eighteen postmortem pancreatic specimens in patients dying of all causes were examined in vitro by EUS for features of CP: (1) echogenic foci, (2) hypoechoic foci, (3) echogenic main pancreatic duct (MPD), (4) accentuated lobular pattern, (5) cysts, (6) irregular MPD, (7) dilated MPD, (8) side branch dilation, and (9) calculi. The pancreata were then examined by 2 pathologists (blinded to the EUS/clinical findings) for histopathologic features of CP.
Six specimens were autolyzed, and in 1 specimen, MPD could not be seen by EUS. In the other 11 patients, 10 had evidence of CP by EUS (> or =3 features) and by histopathologic examination (> or =2 features). One patient did not have CP by both EUS and histologic examination.
Endoscopic ultrasound accurately detected CP, when compared with histopathologic examination. The presence of 3 or more features of CP correlates with the histologic diagnosis of CP, however, up to 3 features are frequently present in elderly patients dying of all causes. Future studies should address the clinical relevance and the specificity of EUS findings of CP in the older population.
Pancreas 08/2009; 38(7):820-4. · 2.39 Impact Factor
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ABSTRACT: Endoscopic biliary sphincterotomy (ES) can cause bleeding, pancreatitis, and perforation. This has, in part, been attributed to the type of electrosurgical current used for ES. No consensus exists on the optimal type of electrosurgical current for ES to maximize safety.
To compare the rates of complications in patients undergoing ES via pure current versus mixed current.
A systematic review of published, prospective, randomized trials that compared pure current with mixed current for ES.
Patients undergoing ES, with random assignment to either current group.
Data were standardized for pancreatitis and postsphincterotomy bleeding. There were insufficient data to analyze perforation risk. A random-effects model was used.
Bleeding, pancreatitis, and perforation.
A total of 804 patients from 4 trials that compared pure current to mixed current were analyzed. The aggregated rate of pancreatitis was 3.8%, 95% confidence interval (CI) 1.0%-6.6%, for the pure-current group versus 7.9%, 95% CI 3.1%-12.7%, for the mixed-current group; the difference was not statistically significant. The rate of bleeding (all severity groups) for the pure-current group was 37.3% (95% CI 27.3%, 47.3%), which was significantly higher than that of the mixed-current group (12.2% [95% CI 4.1%, 20.3%]). Mild bleeding was significantly more frequent with pure current (28.9% [95% CI 16.3, 41.4]) compared with mixed current (9.4% [95% CI 2.1%, 16.8%]).
Variables, including endoscopist skill and cannulation difficulty, were difficult to measure.
The rate of pancreatitis in patients who underwent ES when using pure current was not significantly different from those when using mixed current. Pure current was associated with more episodes of bleeding, primarily mild bleeding. Data were insufficient to analyze the perforation risk.
Gastrointestinal Endoscopy 09/2007; 66(2):283-90. · 4.88 Impact Factor
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ABSTRACT: Numerous published studies have shown the high diagnostic performance of both EUS and MRCP compared with ERCP for the detection of choledocholithiasis.
We undertook a systematic review of all published randomized, prospective trials that compared EUS with MRCP with the primary aim being to compare the overall diagnostic accuracy for the detection of choledocholithiasis in patients with suspected biliary disease.
A MEDLINE review was performed. We identified 5 randomized, prospective, blinded trials comparing MRCP and EUS for the detection of choledocholithiasis, with subsequent ERCP or intraoperative cholangiography as a criterion standard. The study-specific variables for EUS and MRCP for choledocholithiasis were calculated from the data, and analyses were performed by using aggregated variables (sensitivity, specificity, positive and negative predictive values, and likelihood ratios).
The pooled data set consisted of 301 patients. The aggregated sensitivities of EUS and MRCP for the detection of choledocholithiasis were 0.93 and 0.85, respectively, whereas their specificities were 0.96 and 0.93, respectively. The aggregated positive predictive values for EUS and MRCP were 0.93 and 0.87, respectively, with the corresponding negative predictive values of 0.96 and 0.92, respectively. Positive likelihood ratios were >10 for both tests, and corresponding negative likelihood ratios approached 0.10 for both tests. No statistically significant differences between EUS and MRCP were found in our analysis.
EUS and MRCP have high diagnostic performance overall. Our analysis showed no statistically significant difference between the modalities. We recommend taking into consideration other factors, such as resource availability, experience, and cost considerations in deciding between these 2 tests.
Gastrointestinal Endoscopy 08/2006; 64(2):248-54. · 4.88 Impact Factor
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ABSTRACT: This study described violent behavior and aggression among youth attending alternative schools, and examined sociodemographic factors associated with such violence. The study involved 494 students attending 10 alternative schools in Houston, Texas. Data were collected between November 2000 and February 2001 by audio-enabled laptop computers equipped with headphones. Students self-reported an average of 11.8 aggressive acts during the week prior to the survey. Students reported a 30-day weapon carrying prevalence of 22.7%; 30-day gun carrying prevalence of 11.1%; 30-day knife or club prevalence of 17.2%; 12-month fighting prevalence of 50.6%; and 12-month prevalence of injuries due to fighting of 6.5%. Association between demographic variables, self-reported aggressive behavior, and other forms of aggression was examined using multivariate logistic regression. Students were divided into four mutually exclusive violence-related categories: no fighting and no weapon (referent), fighting only, carrying weapon only, fighting and weapon carrying. Student aggression was significantly associated with fighting and weapon carrying, with incremental increases at each level (OR 1.1 per unit of increase, 95% CI 1.1-1.2) and in presence of the covariates. Among Houston's alternative school students, the prevalence of violent behavior (weapon carrying, gun carrying, knife or club carrying, fighting, and treatment by a doctor or nurse for injuries) is higher compared to regular high school students. Aggression related strongly to weapon carrying and fighting in the sample. Data indicate alternative school youth urgently need prevention and treatment programs to help them live in safer environments.
Journal of School Health 12/2002; 72(9):357-62. · 1.34 Impact Factor
