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RISS 인기검색어
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- 저자 : Thomas R. McCarty (검색결과 3 건)
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Thomas R. McCarty,Ahmad Najdat Bazarbashi,Basile Njei,Marvin Ryou,Harry R. Aslanian,Thiruvengadam Muniraj 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.5
Background/Aims: Percutaneous liver biopsy (PCLB) or transjugular liver biopsy (TJLB) have traditionally been performed toobtain a sample of hepatic tissue; however, endoscopic ultrasound-guided liver biopsy (EUSLB) has become an attractive alternative. The aim of this study was to compare the efficacy and safety of EUSLB, PCLB, and TJLB. Methods: Search strategies were developed in accordance with PRISMA and MOOSE guidelines. Major outcomes included thefollowing: adequacy of biopsy specimens (i.e., complete portal triads [CPT], total specimen length [TSL] in mm, and length oflongest piece [LLP]) in mm), and rate of adverse events. Only studies comparing all biopsy approaches (i.e., EUSLB, PCLB, andTJLB) were included. Results: Five studies (EUSLB [n=301]; PCLB [n=176]; and TJLB [n=179]) were included. Biopsy cumulative adequacy rates forEUSLB, PCLB, and TJLB were 93.51%, 98.27%, and 97.61%, respectively. Based on the subgroup analysis limited to EUS biopsyneedles in current clinical practice, there was no difference in biopsy adequacy or adverse events for EUSLB compared to PCLB andTJLB (all p>0.050). A comparison of EUSLB and PCLB revealed no difference between specimens regarding both CPT (p=0.079) andLLP (p=0.085); however, a longer TSL (p<0.001) was observed. Compared to TJLB, EUSLB showed no difference in LLP (p=0.351),fewer CPT (p=0.042), and longer TSL (p=0.005). Conclusions: EUSLB appears to be a safe, minimally invasive procedure that is comparable to PCLB and TJLB regarding biopsyspecimens obtained and rate of adverse events associated with each method.
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Diogo Turiani Hourneaux de Moura,Thomas R. McCarty,Pichamol Jirapinyo,Igor Braga Ribeiro,Galileu Ferreira Ayala Farias,Marvin Ryou,Linda S. Lee,Christopher C. Thompson 대한소화기내시경학회 2020 Clinical Endoscopy Vol.53 No.5
Background/Aims: Endoscopic ultrasound fine-needle aspiration (EUS-FNA) is preferred for sampling of lymph nodes (LNs) adjacentto the gastrointestinal wall; however, fine-needle biopsy (FNB) may provide improved diagnostic outcomes. This study aimed toevaluate the comparative effcacy and safety of FNA versus FNB for LN sampling. Methods: This was a multicenter retrospective study of prospectively collected data to evaluate outcomes of EUS-FNA and EUS-FNBfor LN sampling. Characteristics analyzed included sensitivity, specificity, accuracy, the number of needle passes, diagnostic adequacyof rapid on-site evaluation (ROSE), cell-block analysis, and adverse events. Results: A total of 209 patients underwent EUS-guided LN sampling. The mean lesion size was 16.22±8.03 mm, with similar sensitivityand accuracy between FNA and FNB ([67.21% vs. 75.00%, respectively, p=0.216] and [78.80% vs. 83.17%, respectively, p=0.423]). Thespecificity of FNB was better than that of FNA (100.00% vs. 93.62%, p=0.01). The number of passes required for diagnosis was notdifferent. Abdominal and peri-hepatic LN location demonstrated FNB to have a higher sensitivity (81.08% vs. 64.71%, p=0.031 and80.95% vs. 58.33%, p=0.023) and accuracy (88.14% vs. 75.29%, p=0.053 and 88.89% vs. 70.49%, p=0.038), respectively. ROSE was asignificant predictor for accuracy (odds ratio, 5.16; 95% confidence interval, 1.15–23.08; p=0.032). No adverse events were reported ineither cohort. Conclusions: Both EUS-FNA and EUS-FNB are safe for the diagnosis of LNs. EUS-FNB is preferred for abdominal LN sampling. EUS-FNA+ROSE was similar to EUS-FNB alone, showing better diagnosis for EUS-FNB than traditional FNA. While ROSE remained asignificant predictor for accuracy, due to its poor availability in most centers, its use may be limited to cases with previous inconclusivediagnoses.
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Marina Tucci Gammaro Baldavira Ferreira,Igor Braga Ribeiro,Diogo Turiani Hourneaux de Moura,Thomas R. McCarty,Alberto Machado da Ponte Neto,Galileu Ferreira Ayala Farias,Antônio Afonso de Miranda Neto 대한소화기내시경학회 2021 Clinical Endoscopy Vol.54 No.6
Background/Aims: The endoscopic management of primary sclerosing cholangitis (PSC)-associated dominant strictures remainschallenging. This systematic review and meta-analysis aimed to compare balloon dilation and stent placement in the treatment ofdominant strictures among PSC patients. Methods: Literature searches on MEDLINE, EMBASE, Cochrane CENTRAL and Lilacs/Bireme were performed for studiespublished until December 2020. Measured outcomes included clinical efficacy, stricture recurrence, cumulative recurrencefree rate,transplant rate, 5-year survival rate, and adverse events (i.e., pancreatitis, cholangitis, bleeding, perforation and death). Results: A total of 5 studies (n=467) were included. Based on pooled analyses, there were no differences in clinical efficacy (riskdifference [RD], -0.13; 95% confidence interval [CI], -0.58 to 0.33; I2=93%) or transplant rates (RD, -0.09; 95% CI, -0.19 to 0.01;I2=0%); however, the risk of occurrence of adverse events was lower with balloon dilatation than with stent placement (RD,-0.34; 95% CI, -0.45 to -0.23; I2=61%). Among the types of adverse events reported, only the rates of cholangitis/bacteremia weresignificantly lower in balloon dilation patients (RD, -0.19; 95% CI, -0.25 to -0.13; I2=51%). Conclusions: Compared to balloon dilation, stent placement for dominant strictures in PSC appeared to have higher complicationrates without significant differences in efficacy.
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