Introduction

Motorized spiral enteroscopy (MSE) has recently been introduced for small bowel evaluation.

Aims & Methods

In this systematic review and meta-analysis, we aim to evaluate the safety and efficacy of MSE for evaluation of small bowel diseases.
A literature search was performed in Embase, PubMed, Medline databases for studies evaluating MSE between Jan-2010 to October-2022. The primary outcome of the study was diagnostic yield with MSE. Secondary outcomes included technical success, procedure duration, depth of maximum insertion (DMI), rate of pan-enteroscopy and adverse events.

Results

10 studies with 961 patients [581(60.5%) males] were included in the analysis. 1,068 MSE procedures were performed by antegrade route in 698, retrograde route in 215 and bidirectional in 155 patients. Technical success was achieved in 94.9% (95% CI 92.9%-96.4%) procedures. The pooled diagnostic yield of MSE was 73.7% (95% CI 70.7% to 76.4%). Pooled rate of pan- enteroscopy by antegrade route was 21.9% (95% CI 18.1%-26.1%), retrograde route was 6.9% (95% CI 2.4%-18.3%) and combined route was 61.2% (95%CI 52.4%-69.3%). Pooled rate of major adverse events was 1.9%(95% CI 1.2%-3.2%).

Conclusion

MSE is a safe and effective tool for evaluating small bowel disorders. High diagnostic yield and low rate of adverse events make it a potential alternative to balloon enteroscopy. However, comparative trials are required in the future.

Introduction

Esophageal Squamous Cell Carcinoma (ESCC) remains a significant global health problem with few therapeutic options and poor prognosis. Camrelizumab, an anti-PD-1 immune checkpoint inhibitor, has been shown in clinical trials to be of potential value in the treatment of advanced or metastatic ESCC as monotherapy or in combination with chemotherapy or anti-angiogenic therapy.

Aims & Methods

The aim of this study is to evaluate the clinical efficacy and safety profile of Camrelizumab in patients with esophageal squamous cell carcinoma, with the main outcomes being progression-free survival (PFS), objective response rate (ORR), and treatment-related adverse events.
We conducted a comprehensive search of PubMed, Scopus, Web of Science, Embase, and Cochrane from their inception to April 2025, focusing on randomized controlled trials (RCTs) and observational studies evaluating Camrelizumab for the treatment of esophageal squamous cell carcinoma. Meta-analyses utilized a random-effects model to calculate odds ratios, mean differences, and 95% confidence intervals for adverse events and total patients.

Results

Out of 1,563 studies initially screened, 15 studies met the inclusion criteria for our meta-analysis, comprising adult patients. Meta-analysis established a median progression-free survival (PFS) of 7.60 months (95% CI: 6.00–9.19). The major pathological response rate (MPR) was 0.42 (95% CI: 0.37–0.48), and the objective response rate (ORR) was 0.53 (95% CI: 0.38–0.68). The R0 resection rate was also remarkably high at 0.98 (95% CI: 0.96–1), and the disease control rate (DCR) was 0.87 (95% CI: 0.64–1). The pathological complete response rate (pCR) was 0.31 (95% CI: 0.20–0.43).
Regarding safety, the most common treatment-related adverse events were leukopenia 0.45 (95% CI: 0.23–0.68), neutropenia 0.30 (95% CI: 0.19–0.41), anemia 0.14 (95% CI: 0.03–0.29), thrombocytopenia 0.09 (95% CI: 0.03–0.17), and elevated transaminases 0.06 (95% CI: 0.02–0.12). Pneumonia 0.17 (95% CI: 0.11-0.23) and hypertension 0.12 (95% CI: 0.06-0.19) were the other immune-related adverse events. The majority of these events were tolerable and within safe parameters.

Conclusion

Camrelizumab demonstrates promising efficacy in the treatment of esophageal squamous cell carcinoma with satisfactory rates of ORR, MPR, and R0 resection. The safety profile is acceptable with controllable adverse effects. These findings support the potential therapeutic value of camrelizumab as a significant treatment strategy in multimodal treatment of esophageal squamous cell carcinoma and the need for further research to optimize its clinical use.

Introduction

POEM is an established treatment modality for achalasia cardia. Monopolar knives (MPK) are typically used for submucosal dissection as well as myotomy during POEM. More recently, a novel bipolar device (BPD) is commercially available for endoscopic dissection and resection procedures.

Aims & Methods

In this study, we aim to compare the performance of MPK with BPD during POEM. This is a prospective, multicenter cohort study including consecutive cases with achalasia cardia who underwent POEM using conventional MPK or a novel BPD from Dec 2019 to Jan 2023. The primary aim of the study was to evaluate the requirement for accessory exchange during POEM procedure. The secondary objectives included technical success, procedure time, adverse events, post-procedure pain and clinical success (Eckardt≤3). Post-operative pain scores were assessed on the day of procedure and first post-operative day using a standardized scale i.e. visual analog scale (VAS). The severity of pain was graded as mild (0-30), moderate (>30-70) and severe (>70).

Results

278 cases (40.9y, 162 males) with achalasia underwent POEM using either a monopolar knife (n=220) or bipolar device (n=58). All the procedures were performed by posterior route (5 O’clock). Median exchange of accessories was significantly lower in the BPD group [3 (2-8) vs 1 (1-2), p=0.001). The use of coagulation forceps for hemostasis or pre-coagulation was significantly less in the BPD group [1(0-6) vs 0(0-1), p=0.001]. There was no difference in technical success, procedure duration and adverse events between the two groups. Post-operative pain was significantly less in the BPD group [40(20-90) vs 40 (20-80), p=0.021]. The proportion of cases with moderate to severe post-operative pain was significantly higher in the MPK group (79.6% vs 56.9%, p=0.001). (Table 1)

Table 1. Comparison of technical and clinical outcomes between the two groups

Conclusion

The novel BPD is safe and effective for performing POEM procedures with the added advantage of minimum exchange of accessories and reduced post-operative pain as compared to MPK.

References

Nabi Z, Chavan R, Ramchandani M, Tsiamoulos Z, Basha J, Goud R, Darisetty S, Reddy N. Endoscopic submucosal dissection and tunneling procedures using a novel all-in-one bipolar device. Endosc Int Open. 2020 Oct;8(10):E1302-E1307.

Disclosure

Dr Zaheer Nabi and Mohan Ramchandani have consultant agreement with Creo Medical

Introduction

Barrett esophagus (BE) represents a pre-malignant condition of the esophagus and current guidelines favor endoscopic eradication therapy (EET). After endoscopic resection for visible neoplastic lesions, field ablation of the residual BE is advised to mitigate the risk of metachronous neoplasia. Cryoablation was introduced as an endoscopic ablative option for BE during the last decade with growing data on outcomes and interest in potential lower adverse events that established ablative techniques.

Aims & Methods

This systematic review and meta-analysis aimed to summarize the existing data regarding safety and efficacy of Cryoablation on BE treatment. A systematic literature search in Medline, Cochrane and Scopus databases was performed until November 2023 for full papers. Safety was considered as the primary outcome, interpreted as the overall rate of procedure related adverse events. Secondary outcomes included post-Cryoablation stricture development, and the complete eradication rates of intestinal metaplasia (CEIM) and dysplasia (CED). In case of heterogeneity, a sub-analysis based on the used device was performed for the primary outcome. Random effects model was used and the results were reported as percentages for pooled rates with 95% Confidence Intervals (95%CIs).

Results

Ten full-paper studies (471 patients; 80.3% men; mean age 62.2-69) were eligible for analysis. The mean BE length, based on Prague classification, was C0-2M2-5. Regarding the primary outcome, the overall adverse events rate was 19.7% (95%CI: 14-25.4; I²=60.66%), although they were mild in the vast majority. ​Strictures warranting treatment were developed in 30 patients, representing 4.4% (95%CI: 1.8-7.1; I²=61.18%). Four studies provided results on CED, yielding a rate of 94.6% (95%CI: 90.1-99.1; I²=61.06%) whereas CEIM was assessed in six studies, reporting a rate of 90.1% (95%CI: 82.3-97.9; I²=87.92%). Given the high heterogeneity in all outcomes, a sub-analysis including studies on focal Cryoablation was performed, revealing a similar rate of adverse events [16.5% (95%CI: 11.1-21.8)] with lower heterogeneity and non-significant heterogeneity (I²=47.7%).

Conclusion

Cryoablation is a safe procedure with initial data showing a potentially low rate of esophageal strictures and comparable rates of dysplasia and BE eradication when compared to other ablative technologies. High-quality prospective studies including comparisons with established ablation techniques are warranted.

Introduction

Critically ill patients are at high risk for upper gastrointestinal (GI) bleeding.¹ Proton pump inhibitors (PPIs) are commonly used for prophylaxis, but their safety and efficacy compared to histamine-2 receptor antagonists (H2 blockers) and placebo remain unclear.^1–4

Aims & Methods

Our systematic review and meta-analysis aims to assess the safety and efficacy of PPIs for preventing upper GI bleeding in critically ill adults. We conducted a comprehensive search of Scopus, Web of Science, PubMed, and Cochrane Central for relevant randomized controlled trials (RCTs) from inception until March 2024. Data were extracted from eligible studies and pooled as mean difference (MD) for continuous outcomes and Odds ratio (OR) for dichotomous data in a random-effect model meta-analysis, using R software.

Results

Nineteen RCTs were included in this meta-analysis with a total of 62221 patients. Our study showed that PPI was superior to control in terms of GI bleeding [RR 0.55, (95% CI, 0.42 to 0.72); P = <0.01]. However, the overall effect did not favor either of the two groups in terms of ICU, mortality rate, and nosocomial infection [MD -1.45, (95% CI, -5.31 to 2.42); P = 0.4], [RR 1.04, (95% CI, 1.00 to 1.09); P = 0.07], and [RR 1.27, (95% CI, 0.98 to 1.65); P = 0.07], respectively.

Conclusion

In conclusion, our findings demonstrated a significant reduction in GI bleeding risk associated with PPI use. At the same time, we did not find a statistically significant difference between PPI and control groups regarding ICU mortality rate, overall mortality rate, or nosocomial infection rates. These findings suggest that PPIs may be effective in reducing upper GI bleeding in critically ill patients. However, further research might be necessary to definitively determine the impact of PPIs on mortality and infection risks in this population.

References

.1. Wang Y, Ye Z, Ge L, et al. Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: Systematic review and network meta-analysis. The BMJ. 2020;368. doi:10.1136/bmj.l6744
2. Kondo Y, Ohbe H, Matsui H, Fushimi K, Tanaka H, Yasunaga H. Proton pump inhibitors versus histamine-2 receptor antagonists for stress ulcer prophylaxis during extracorporeal membrane oxygenation: a propensity score-matched analysis. BMJ Open. 2020;10(9):e037534. doi:10.1136/bmjopen-2020-037534
3. Alshamsi F, Belley-Cote E, Cook D, et al. Efficacy and safety of proton pump inhibitors for stress ulcer prophylaxis in critically ill patients: A systematic review and meta-analysis of randomized trials. Crit Care. 2016;20(1). doi:10.1186/S13054-016-1305-6
4. Jung YS, Park JH, Park CH. Impact of proton pump inhibitors on the risk of small bowel or colorectal bleeding: A systematic review and meta-analysis. United European Gastroenterol J. 2023;11(9):861-873. doi:10.1002/ueg2.12448

Introduction

Gastric outlet obstruction (GOO) is a debilitating condition commonly caused by malignant or benign diseases, impairing gastric emptying and nutritional status. While surgical gastrojejunostomy (SGJ) has traditionally been the standard palliative approach, endoscopic ultrasound-guided gastrojejunostomy (EUSGJ) has recently emerged as a minimally invasive alternative. This systematic review and meta-analysis aimed to compare the efficacy and safety of EUSGJ versus SGJ for the management of GOO.

Aims & Methods

A systematic search of PubMed, Embase, Medline, and Cochrane Library was conducted to identify studies directly comparing EUSGJ and SGJ in adult patients with GOO. Nine retrospective studies comprising 1,086 patients (654 EUSGJ; 432 SGJ) were included. Primary outcomes included technical and clinical success, length of hospital stay (LOS), operative time, and overall complication rates. Secondary outcomes included infection, ileus, hemorrhage, perforation, and re-intervention. Meta-analyses were performed using fixed or random effects models depending on data heterogeneity.

Results

EUSGJ was significantly superior to SGJ in terms of technical success (OR = 0.16; 95% CI: 0.05–0.45; p = 0.0006), shorter operative time (MD = –96.89 minutes; 95% CI: –146.16 to –47.61; p < 0.00001), reduced postoperative LOS (MD = –4.79 days; 95% CI: –6.52 to –3.06; p < 0.0001), lower overall complication rates (OR = 0.24; 95% CI: 0.17–0.33; p < 0.00001), reduced postoperative ileus (OR = 0.07; 95% CI: 0.02–0.17; p < 0.00001), and fewer infections (OR = 0.17; 95% CI: 0.08–0.37; p < 0.00001). No statistically significant differences were found regarding clinical success, re-intervention, hemorrhage, or perforation.

Conclusion

EUSGJ demonstrates superior procedural outcomes and safety profiles compared to SGJ in the management of GOO and represents a valuable tool in expert hands. However, further prospective studies and randomized trials are necessary to validate these findings, assess long-term outcomes, and define its role within individualized patient care and clinical guidelines.

Disclosure

No conflict of interest