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- 저자 : Jake S. Jacob (검색결과 2 건)
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Jake S. Jacob,Michelle E. Lee,Erin Y. Chew,Aaron P. Thrift,Robert J. Sealock 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.2
Background/Aims: The American Society for Gastrointestinal Endoscopy (ASGE) revised its guidelines for risk stratification ofpatients with suspected choledocholithiasis. This study aimed to assess the diagnostic performance of the revision and to compare itto the previous guidelines. Methods: We conducted a retrospective cohort study of 267 patients with suspected choledocholithiasis. We identified high-riskpatients according to the original and revised guidelines and examined the diagnostic accuracy of both guidelines. We measured theassociation between individual criteria and choledocholithiasis. Results: Under the original guidelines, 165 (62%) patients met the criteria for high risk, of whom 79% had confirmedcholedocholithiasis. The categorization had a sensitivity and specificity of 68% and 55%, respectively, for the detectionof choledocholithiasis. Under the revised guidelines, 86 (32%) patients met the criteria for high risk, of whom 83% hadcholedocholithiasis. The revised categorization had a lower sensitivity and higher specificity of 37% and 80%, respectively. Thepositive predictive value of the high-risk categorization increased with the revision, reflecting a potential decrease in diagnosticendoscopic retrograde cholangiopancreatograpies (ERCPs). Stone visualized on imaging had the greatest specificity forcholedocholithiasis. Gallstone pancreatitis was not associated with the risk for choledocholithiasis. Conclusions: The 2019 revision of the ASGE guidelines decreases the utilization of ERCP as a diagnostic modality and offers animproved risk stratification tool.
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Endoscopic vacuum therapy for treatment of spontaneous and iatrogenic upper gastrointestinal defects
Kavea Panneerselvam,Jake S. Jacob,Ronald E. Samuel,Andy Tau,Gyanprakash A. Ketwaroo,Wasif M. Abidi,Robert J. Sealock 대한소화기내시경학회 2023 Clinical Endoscopy Vol.56 No.6
Background/Aims: Endoscopic vacuum therapy (EVT) can heal a variety of defects within the gastrointestinal (GI) tract via applyingnegative pressure, which reduces the defect size, aspirates the infected fluid, and promotes granulation tissue. Here we present our ex-perience with EVT as it relates to both spontaneous and iatrogenic upper GI tract perforations, leaks, and fistulas. Methods: This retrospective study was conducted at four large hospital centers. All patients who underwent EVT between June 2018and March 2021 were included. Data on multiple variables were collected, including demographics, defect size and location, numberand intervals of EVT exchanges, technical success, and hospital length of stay. Student t-test and the chi-squared test were used to ana-lyze the data. Results: Twenty patients underwent EVT. The most common defect cause was spontaneous esophageal perforation (50%). The mostcommon defect location was the distal esophagus (55%). The success rate was 80%. Seven patients were treated with EVT as the prima-ry closure method. The mean number of exchanges was five with a mean interval of 4.3 days between exchanges. The mean length ofhospital stay was 55.8 days. Conclusions: EVT is a safe and effective initial management option for esophageal leaks and perforations.
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