Search

Background and Aim: The study aims to evaluate the feasibility of body mass index (BMI)‐based individualized small bowel preparation for computed tomography enterography (CTE). Methods: In this prospective randomized controlled study, patients undergoing CTE were randomly assigned to the individualized group or standardized group. Those in individualized group were given different volumes of mannitol solution based on BMI (1000 mL for patients with BMI < 18.5 kg/m2, 1500 mL for patients with 18.5 kg/m2 ≤ BMI < 25 kg/m2 and 2000 mL for patients with BMI ≥ 25 kg/m2) while patients in the standardized group were all asked to consume 1500‐mL mannitol solution. CTE images were reviewed by two experienced radiologists blindly. Each segment of the small bowel was assessed for small bowel image quality and disease detection rates. Patients were invited to record a diary regarding adverse events and acceptance. Results: A total of 203 patients were enrolled and randomly divided into two groups. For patients with BMI < 18.5 kg/m2, 1000‐mL mannitol solution permitted a significantly lower rate of flatulence (P = 0.045) and defecating frequency (P = 0.011) as well as higher acceptance score (P = 0.015), but did not affect bowel image quality and diseases detection compared with conventional dosage. For patients with BMI ≥ 25 kg/m2, 2000‐mL mannitol solution provided better overall image quality (P = 0.033) but comparable rates of adverse events and patients' acceptance compared with conventional dosage. Conclusions: Individualized bowel preparation could achieve both satisfactory image quality and patients' acceptance thus might be an acceptable alternative in CTE. [ABSTRACT FROM AUTHOR]

Introduction: The safety and efficacy of cold snare polypectomy (CSP) compared to those of cold endoscopic mucosal resection (CEMR) have been reported. This meta-analysis compared the efficacy and safety of CEMR and CSP. Methods: PubMed, Embase, Web of Science, and Cochrane Library databases were systematically searched to identify randomized controlled trials comparing the efficacy and safety of CEMR and CSP in removing 3–10 mm polyps. The outcomes assessed included complete resection rate, intraoperative bleeding rate, delayed bleeding rate, perforation, and polyp removal time. The results are reported as risk ratios (RR) and 95% confidence intervals (CIs) derived from a Mantel-Haenszel random-effects model. Results: Seven studies comprising 1,911 polyps were included in the analysis. The complete resection rate of CEMR was comparable to that of CSP (RR: 1.01, 95% CI: 0.99–1.04, p = 0.32). Comparable results were also demonstrated for intraoperative bleeding rate (polyp-based analysis: RR: 1.22, 95% CI: 0.33–4.43, p = 0.77), delayed bleeding rate (polyp-based analysis: RR: 1.34, 95% CI: 0.44–4.15, p = 0.61), and polyp removal time (mean difference: 28.31 s, 95% CI: −21.40–78.02, p = 0.26). No studies reported cases of perforation. Conclusion: CEMR has comparable efficacy and safety to CSP in removing 3–10 mm polyps. Further randomized controlled trials with long-term follow-up are warranted to compare and validate efficacy. [ABSTRACT FROM AUTHOR]

Helicobacter pylori (H. pylori) infection is a major cause of duodenal ulcers, gastric ulcers, and gastric cancer. However, the optimal duration for H. pylori eradication therapy remains controversial. Most studies have mainly focused on triple therapy, and there is insufficient research on bismuth-containing quadruple therapy. The aim of this study was to compare the clinical effect of the 10-day bismuth-containing quadruple treatment regimen with the 14-day regime in eradicating H. pylori. We searched PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials published in English until May 2022 according to the eligibility criteria. Summary risk ratios (RRs) and 95% confidence intervals (CIs) for eradication rates, adverse effects, and compliance were calculated for included studies. Four studies, involving 1173 patients, were eligible for inclusion. The eradication rate was similar in the 10-day treatment group and the 14-day treatment group in the intention-to-treat analysis (RR 0.97, 95% CI 0.93 to 1.01). Meanwhile, the incidence of adverse effects was lower in patients who received 10 days of treatment than in those who received 14 days of treatment and patients' compliance was almost the same between two groups. Compared to the 14-day bismuth-containing quadruple regimens, 10-day regimens had similar efficacy and lower incidence of adverse effects. Therefore, the 10-day regimen is safe and well-tolerated and should be recommended for H. pylori infection. [ABSTRACT FROM AUTHOR]

Background and Aim: Lugol chromoendoscopy is the standard technique to detect an esophageal squamous cell carcinoma (ESCC). However, a high concentration of Lugol's solution can induce mucosal injury and adverse events. We aimed to investigate the optimal concentration of Lugol's solution to reduce mucosal injury and adverse events without degrading image quality. Methods: This was a two‐phase double‐blind randomized controlled trial. In phase I, 200 eligible patients underwent esophagogastroduodenoscopy and then were randomly (1:1:1:1:1) sprayed with 1.2%, 1.0%, 0.8%, 0.6%, or 0.4% Lugol's solution. Image quality, gastric mucosal injury, adverse events, and operation satisfaction were compared to investigate the minimal effective concentration. In phase II, 42 cases of endoscopic mucosectomy for early ESCC were included. The patients were randomly assigned (1:1) to the minimal effective (0.6%) or conventional (1.2%) concentration of Lugol's solution for further comparison of the effectiveness. Results: In phase I, the gastric mucosal injury was significantly reduced in 0.6% group (P < 0.05). Furthermore, there was no statistical significance in image quality between 0.6% and higher concentrations of Lugol's solution (P > 0.05, respectively). It also showed that the operation satisfaction decreased in 1.2% group compared with the lower concentration groups (P < 0.05). In phase II, the complete resection rate was 100% in both groups, while 0.6% Lugol's solution showed higher operation satisfaction (W = 554.500, P = 0.005). Conclusions: The study indicates that 0.6% might be the optimal concentration of Lugol's solution for early detection and delineation of ESCC, considering minimal mucosal injury and satisfied image. The registry of clinical trials: ClinicalTrials.gov (NCT03180944). [ABSTRACT FROM AUTHOR]

Objectives: Esophageal cancer is a high-mortality disease. Esophagectomy is the most effective method to treat esophageal cancer, accompanied with a high incidence of post-operation complications. The anastomosis has a close connection to many severe post-operation complications. However, it remains controversial about the choice of intrathoracic anastomosis (IA) or cervical anastomosis (CA). The study was conducted to compare the clinical outcomes between the two approaches. Methods: We searched databases for both randomized controlled trials (RCTs) and cohort studies comparing post-operation outcomes between IA and CA. Primary outcomes were the incidences of anastomotic leakage and mortality. Secondary outcomes were the incidences of anastomotic stenosis, pneumonia and re-operation. Results: Twenty studies with a total of 7,479 patients (CA group: n = 3,183; IA group: n = 4296) were included. The results indicated that CA group had a higher incidence of anastomotic leakage than IA group (odds ratio [OR] = 2.05, 95% confidence intervals [CI] = 1.61–2.60, I2 = 53.31%, P < 0.01). Subgroup analyses showed that CA group had higher incidences of type I (OR = 2.19, 95%CI = 1.05–4.57, I2 = 0.00%, P = 0.04) and type II (OR = 2.75, 95%CI = 1.95–3.88, I2 = 1.80%, P < 0.01) anastomotic leakage than IA group. No difference was found in type III anastomotic leakage (OR = 1.23, 95%CI = 0.82–1.86, I2 = 20.92%, P = 0.31). The 90-day mortality (OR = 1.66, 95%CI = 1.11–2.47, I2 = 0.0%, P = 0.01) in IA group were lower than that in CA group. No difference was found in in-hospital mortality (OR = 1.31, 95%CI = 0.91–1.88, I2 = 0.00%, P = 0.15) and 30-day mortality (OR = 1.08, 95%CI = 0.69–1.70, I2 = 0.00%, P = 0.74). Conclusions: IA might be a better anastomotic approach than CA, with a lower incidence of anastomosis leakage and no increase in short-term mortality. Significant heterogeneity and publication bias might limit the reliability of the results. More high-quality studies are needed to verify and update our findings. [ABSTRACT FROM AUTHOR]

Background & Aims: Antibiotic resistance of Helicobacter pylori (H. pylori) is increasing worldwide, and bismuth quadruple therapy has been recommended as a first‐line regimen in many areas. This study aimed to investigate whether bismuth would improve the eradication rate (ER) of clarithromycin‐/metronidazole‐/levofloxacin‐resistant H. pylori strains and how much additional efficacy bismuth could achieve. Methods: PubMed, EMBASE, Web of Science, and Cochrane Central databases for randomized controlled trials were systematically searched by two independent reviewers until 15 January 2022. Pooled ERs of clarithromycin‐/metronidazole‐/levofloxacin‐resistant H. pylori strains were compared between bismuth‐containing and non‐bismuth therapies. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random‐effects model. Results: Eight studies enrolling 340 individuals were included. The RRs of pooled ERs compared between bismuth‐containing and non‐bismuth therapies were 1.83 for clarithromycin‐resistant strains (95% CI 1.16–2.89, pooled ER: 76.9% vs. 36.6%, p =.009, I2 = 0%), 1.39 for metronidazole‐resistant strains (95% CI 1.09–1.78, pooled ER: 86.8% vs. 60.9%, p =.008, I2 = 37%), 2.75 for dual clarithromycin/metronidazole‐resistant strains (95% CI 1.01–7.52, pooled ER: 76.9% vs. 18.2%, p =.05, I2 = 0%), and 1.04 for levofloxacin‐resistant strains (95% CI 0.56–1.93, pooled ER: 63.4% vs. 54.3%, p =.90; I2 = 60%). Bismuth significantly increased the ERs of clarithromycin‐, metronidazole‐, and dual‐resistant strains by 40%, 26%, and 59%, respectively. Subgroup analysis of treatment duration showed that the significantly higher eradication rate for antibiotic‐resistant strains in bismuth‐containing therapy than non‐bismuth therapy was only observed in 14‐day treatment regimens and not in 7‐day regimens (p =.02 and.17, respectively). Conclusions: Bismuth was most effective in improving the ERs of dual‐resistant H. pylori strains, followed by clarithromycin‐ and metronidazole‐resistant strains. Prolonged treatment duration might effectively improve the efficacy of bismuth in overcoming antibiotic resistance. [ABSTRACT FROM AUTHOR]

Though some studies have reported navigated high tibial osteotomy (HTO) is a useful procedure to correct knee deformity. There is still great controversy whether navigated HTO can achieve better accuracy of limb alignment and greater clinical outcomes. Current meta-analysis was conducted to investigate whether better radiographic outcomes and clinical outcomes could be acquired in navigated HTO compared with the conventional procedure. We conducted a literature search in the electronic databases, including Medline, Embase, the Cochrane Library, and Web of Science. We identified studies published before August 2020. We also checked the references of the related articles for any relevant studies. We strictly followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review. This research was performed using Review Manager 5.4 software. Fourteen articles were included, involving 1399 knees. Our meta-analysis indicated that patients undergoing navigated HTO had significantly better outcomes in outliers of aimed limb alignment (RD=−0.24, 95% CI: =−0.34 to −0.13, p < 0.01), outliers of aimed tibial posterior slope (TPS) (RD=−0.41, 95% CI: −0.51 to −0.30, p < 0.01), Range of Motion (ROM) (MD = 6.37, 95%CI: 0.83–11.91, p = 0.02), and American knee society knee score (AKS knee score) (MD = 3.88, 95%CI: 1.37–6.39, p = 0.002). No significant differences were found in Lysholm score (MD = 1.30, 95%CI: −0.31 to 2.90, p = 0.11), American knee society function score (AKS function score) (RD = 1.42, 95%CI: −0.15 to 2.99, p = 0.08), complications (RD=−0.01, 95% CI: = −0.05 to 0.04, p = 0.77), delayed union (RD=−0.01, 95% CI: = −0.02 to 0.03, p = 0.59), and reoperation (RD = 0, 95% CI: −0.09 to 0.10, p = 0.98) between the two groups. The operation time in the navigated group was 15.46 min longer than in the conventional group. Navigated HTO provided more accurate and reproducible radiographic outcomes in the correction of the malalignment than conventional techniques, and there is no difference in the risk of complications compared with conventional HTO. However, it is unclear whether navigation HTO can achieve better clinical results. More randomized controlled trials (RCTs) with high quality, large sample size, and sufficient follow-up period are required. [ABSTRACT FROM AUTHOR]

BACKGROUND: Spinal cord injury (SCI) results in neurological dysfunction of the spinal cord below the injury. OBJECTIVE: To explore the immediate and long-term effects of robotic-assisted gait training (RAGT) on the recovery of motor function and walking ability in children with thoracolumbar incomplete SCI. METHODS: Twenty-one children with thoracolumbar incomplete SCI were randomly divided into the experimental (n = 11) and control groups (n = 10). The control group received 60 min of conventional physical therapy, and the experimental group received 30 min of RAGT based on 30 minutes of conventional physical therapy. Changes in walking speed and distance, physiological cost index (PCI), lower extremity motor score (LEMS), SCI walking index and centre-of-pressure (COP) envelope area score were observed in both groups of children before and after eight weeks of training. The primary outcome measures were the 10-metre walk test (10MWT) and six-minute walk distance (6MWD) at preferred and maximal speeds. In addition, several other measures were assessed, such as postural control and balance, lower limb strength and energy expenditure. RESULTS: Compared with control group, the self-selected walk speed (SWS), maximum walking speed (MWS), 6MWD, PCI, LEMS, COP, and Walking Index for Spinal Cord injury II (WISCI II) of experimental group were improved after treatment. The 6MWD, PCI, COP, and WISCI II after eight weeks of treatment were improved in experimental group. All indicators were not identical at three different time points when compared between two groups. Pairwise comparisons in experimental group suggested that the SWS, MWS, 6MWD, PCI, LEMS, COP, and WISCI II after treatment were higher than those before treatment. The 6MWD, LEMS, COP, and WISCI II after treatment were higher than at the one-month follow-up appointment. The SWS, PCI, LEMS, COP, and WISCI II at the eight-week follow-up appointment were improved. CONCLUSION: Robotic-assisted gait training may significantly improve the immediate motor function and walking ability of children with thoracolumbar incomplete SCI. [ABSTRACT FROM AUTHOR]

Fangcang hospitals, as tentative hospitals built to treat a huge turnover of patients with mild coronavirus disease 2019 (COVID-19) infections, have played a pivotal role to slow down the pandemic spread in China in 2020. However, anxiety and sleep disorders remain tough to address during the treatments. In this study, group psychological intervention in combination with pulmonary rehabilitation exercises were conducted in the trial group for the patients with mild COVID-19 infections in a Fangcang Hospital to mitigate the patients' anxiety and sleep disorders, while conventional nursing methods were done in the control group, with 70 randomly picked patients in each group. Effects were assessed through questionnaire method using state anxiety questionnaire (SAI) and Pittsburgh sleep quality index scale (PQSI) rating investigation. Results showed that both SAI and PSQI scores of the trial group were significantly lower than those of the control group (P < 0.05). The SAI scores of the trial group and the control group were 38.5 ± 13.2 and 45.8 ± 10.4 points (t = 3.600, P < 0.001), respectively, and the PSQI scores were 5.6 ± 3.0 and 7.1 ± 3.0 points (t = 2.982, P < 0.01), respectively. Our methods have significant advantages over conventional nursing methods to mitigate anxiety and sleep disorders for the patients with mild COVID-19 infections in the Fangcang Hospital. [ABSTRACT FROM AUTHOR]

Background and Aims: Add‐on devices have been widely used in clinical practice. The aim of this meta‐analysis was to compare the adenoma detection rate between Endocuff‐assisted colonoscopy (EAC) and cap‐assisted colonoscopy (CAC). Methods: PubMed, EMBASE, SCOPUS, and Cochrane databases were searched. Outcomes included adenoma detection rate, cecal intubation rate, cecal intubation time, and withdrawal time. Dichotomous data were pooled to obtain the odds ratio or risk ratio. Continuous data were pooled using the mean difference. Results: Of the 240 articles reviewed, six randomized controlled trials were included, with a total of 1994 patients. In the meta‐analysis, no statistical difference in adenoma detection rate was detected between EAC and CAC (47.0% vs 45.1%; P = 0.33). EAC significantly improved detection rate of diminutive adenomas/polyps compared with CAC (P = 0.01). Cecal intubation was achieved in 96.5% in EAC group and 97.9% in CAC group (P = 0.04). Besides, no statistical difference was found in cecal intubation time (P = 0.86), withdrawal time (P = 0.88), small adenomas/polyps (P = 0.60), or large adenomas/polyps (P = 0.95). Conclusion: EAC and CAC have their respective merits. EAC significantly improve the detection of diminutive adenomas/polyps. CAC was better in cecal intubation rate. [ABSTRACT FROM AUTHOR]

Objective: In this study we aimed to compare the efficacy and safety of two personalized rescue therapies for Helicobacter pylori infection. Methods: An open‐label, single‐center, randomized controlled trial was conducted. Patients who had failed one or two regimens for H. pylori infection were randomized to receive a 14‐day bismuth‐containing quadruple therapy guided by antimicrobial susceptibility testing (AST) or personal medication history (PMH). In the AST group, either two of amoxicillin, clarithromycin, metronidazole or levofloxacin were prescribed according to the AST. In the PMH group, amoxicillin plus either levofloxacin or furazolidone were prescribed based on the patient's history of quinolone use. The primary outcomes were eradication rates confirmed by an urea breath test 6 weeks after treatment. The secondary outcomes were adherence, incidence of adverse events (AE) and cost‐effectiveness. Results: Altogether 164 with a positive culture received AST‐guided therapy and 192 received PMH‐guided therapy, respectively. Both AST‐ and PMH‐guided therapies achieved comparable eradication rate (intention‐to‐treat analysis: 78.10% vs 74.29%, P = 0.42; per‐protocol analysis: 87.10% vs 88.64%, P = 0.80). The AST clarithromycin regimen had a lower per‐protocol eradication rate than the levofloxacin (75.47% vs 96.30%, P = 0.03) or furazolidone‐containing regimen (75.47% vs 92.75%, P = 0.02). Both groups had high compliance with low incidences of AE, and PMH‐guided therapy had a lower medical cost. Conclusions: AST‐guided therapy was not superior to PMH‐guided therapy as a second‐ or third‐line treatment for H. pylori infection. Considering the cost‐effectiveness, PMH therapy is clinically more favorable. [ABSTRACT FROM AUTHOR]

Objective: To compare the performances, tolerability and acceptability of mannitol and polyethylene glycol (PEG) as oral contrast agents in patients undergoing computed tomography enterography (CTE). Methods: Patients aged 18‐75 years indicated for CTE were randomized to receive either mannitol or PEG as contrast agents. The coronal reconstructed images of each abdominal quadrant were assessed for maximum distention, proportion of distended bowel loops, presence of inhomogeneous contents and visibility of the small bowel wall. Overall subjective imaging quality assessment and patients' tolerability and acceptability were recorded. Results: Seventy patients were enrolled and randomized into two groups. In the per‐protocol analysis, no significant differences in imaging quality was found in bowel distention maximum diameter, wall visibility and intestinal homogeneity (all P > 0.05). The mean nausea score was lower in the mannitol group (0 [0‐0] vs 1.0 [0‐3.0], P < 0.001). Mannitol was superior to PEG in taste (9.0 [8.0‐10.0] vs 7.0 [5.0‐8.0], P < 0.001), patients' willingness to reuse the drug (9.0 [8.0‐10.0] vs 8.0 [7.0‐9.0], P = 0.036), satisfaction (9.0 [8.0‐10.0] vs 8.0 [7.0‐9.0], P = 0.022) and ease of completion (9.0 [8.0‐9.3] vs 8.0 [6.5‐9.0], P = 0.030). Conclusions: Both mannitol and PEG provided good bowel distention and visualization of the bowel wall. However, mannitol was significantly superior to PEG in patients' tolerability and acceptability. [ABSTRACT FROM AUTHOR]

Background and Study Aims: Ideal bowel preparation for colonoscopy requires complete removal of fluid and foam from the colon. Polyethylene glycol (PEG) is widely used for bowel preparation, with antifoaming agents such as simethicone commonly used in combination with PEG. Data on the effect of simethicone on the adenoma detection rate (ADR) were limited. This study therefore aimed to investigate whether preprocedure simethicone could increase the ADR.Patients and Methods: This was a prospective, multicenter, endoscopist-blinded randomized controlled trial involving consecutive patients who underwent colonoscopy in six centers in China. Patients were randomly assigned to one of two groups: PEG plus simethicone or PEG alone. The primary outcome was ADR; secondary outcomes were quality of bowel preparation, measured by the Boston bowel preparation scale (BBPS) and bubble scores.Results: 583 patients were included. More adenomas were detected in the PEG plus simethicone group than in the PEG alone group (ADR 21.0 % vs. 14.3 %, P = 0.04; advanced ADR 9.0 % vs. 7.0 %, P = 0.38). The mean number of adenomas detected was 2.20 ± 1.36 vs. 1.63 ± 0.89 (P = 0.02). Patients in the PEG plus simethicone group showed better bowel cleansing efficacy: BBPS ≥ 6 in 88.3 % vs. 75.2 % (P < 0.001) and bubble scores of 1.00 ± 1.26 vs. 3.98 ± 2.50 (P < 0.001). Abdominal bloating was reported less frequently in the PEG plus simethicone group (7.8 % vs. 19.7 %, P < 0.001) than in the PEG alone group.Conclusion: Combined use of PEG and simethicone is associated with a significantly increased ADR in a Chinese population. [ABSTRACT FROM AUTHOR]

Background and study aims Interval colorectal cancers detected after screening colonoscopy are more likely to be associated with missed lesions in the proximal colon. The aim of this study was to determine whether segmental re-examination of the proximal colon could increase the proximal adenoma detection rate (ADR) and to evaluate the time-effectiveness of this approach. Patients and methods Patients undergoing colonoscopy were recruited into the prospective randomized controlled study. They were randomly assigned to the segmental re-examination group, in which the proximal colon was examined twice segmentally, and a control group in which the withdrawal time was extended (EWT). Detection rates were calculated and compared for all polyps and adenomas in both the proximal colon and the whole colon. Withdrawal times were recorded and compared. Results A total of 360 patients were included in the study (re-examination 178 vs. EWT 182). The proximal ADR in the re-examination group was higher than that in the EWT group (33.1 % vs. 23.6 %; P = 0.045). More proximal adenomas were detected per patient in the re-examination group (0.54 vs. 0.36; P = 0.048). The ADR of the whole colon was similar in the two groups. Proximal withdrawal time was also similar (re-examination 4.29 ± 1.23 minutes vs. EWT 4.34 ± 1.36 minutes; P = 0.74). In addition, there was no statistically significant difference in the total duration of the colonoscopy between the two groups. Conclusions Segmental re-examination of the proximal colon increased the proximal ADR and the number of proximal adenomas detected, and was accomplished easily and safely without increasing the overall examination time.Trial Registration: ClinicalTrials.gov (NCT02581475). [ABSTRACT FROM AUTHOR]

Objective. We aimed to investigate the effectiveness of acupoint polyglactin 910 (PGLA) embedding in patients with cervical spondylotic radiculopathy (CSR). Methods. A total of 102 CSR patients with neck and shoulder pain were recruited and assigned randomly into three groups: the sham acupoint embedding (SAE) group, the middle-layer acupoint PGLA embedding (MAPE) group, and the deep-layer acupoint PGLA embedding (DAPE) group. The primary outcomes were Visual Analog Scale (VAS) scores showing the analgesic effects of treatment. Secondary outcomes included clinical symptoms (evaluated by the Yasuhisa Tanaka 20 (YT-20) score and the neck disability index (NDI)) and patient health status (evaluated by the 36-item short-form survey (SF-36)) as reported in the trial. Results. Compared with the SAE group, VAS scores were significantly reduced at 1, 2, 3, 4, and 10 weeks after the first treatment in both the DAPE and MAPE groups (P < 0.001). Moreover, there were statistically significant increases in the weekly YT-20 scores and significant reductions of the weekly NDI scores compared with baseline values in both the DAPE and MAPE groups (P < 0.001). Compared with baseline values, both the physical component summary (PCS) and the mental component summary scores of the SF-36 at 2, 3, 4, and 10 weeks were significantly higher in the DAPE and MAPE groups (P < 0.001). There were significant lower VAS scores (P < 0.01), higher PCS scores (P < 0.05) at 3 weeks, and lower NDI scores (P < 0.05) at 4 weeks in the DAPE group compared with the MAPE group. Conclusions. Both DAPE and MAPE showed significant and long-lasting effects on alleviating pain and improving clinical symptoms as well as quality of life in CSR patients with neck and shoulder pain. A more intense effect was seen in the DAPE group compared with the MAPE group. [ABSTRACT FROM AUTHOR]

Background and study aims Owing to the indistinctive endoscopic appearance of gastric intestinal metaplasia (GIM), gastric intraepithelial neoplasia (GIN), and early gastric cancer (EGC), a significant number of such lesions may be missed during surveillance endoscopy. The aim of this clinical trial was to assess the value of combined computed virtual chromoendoscopy (flexible spectral imaging color enhancement [FICE]) and probe-based confocal laser endomicroscopy (pCLE) for in vivo detection of GIM, GIN, and EGC. Patients and methods This was a multicenter, randomized controlled trial performed in 238 patients at four tertiary centers. Patients were randomized to FICE-guided pCLE with targeted biopsies (group A) or FICE with standard biopsies (group B). The diagnostic yield of GIM, GIN, or EGC was compared between the two groups. Results On a per-patient assessment, the diagnostic yield for GIM/GIN/EGC was 73.3 % (88/120) in group A and 63.6 % (75/118) in group B (P = 0.09). On a per-biopsy analysis, FICE-guided pCLE with targeted biopsies significantly increased the diagnostic yield of GIM/GIN/EGC vs. FICE with standard biopsies, from 31.5 % (252/800) to 75.1 % (313/417) (P < 0.001). In addition, pCLE-guided targeted biopsies led to a significant 48.5 % decrease in the number of biopsies per patient vs. FICE with standard biopsies (P < 0.001). Conclusions Real-time pCLE and targeted biopsies after FICE improved the diagnostic yield for the detection of GIM, GIN, and EGC, and only required about half the number of biopsies vs. FICE with standard biopsies. This may allow a better regimen for endoscopic surveillance and subsequent treatment of patients with premalignant and malignant gastric abnormalities.Trial registered at ClinicalTrials.gov (NCT02515721). [ABSTRACT FROM AUTHOR]

The efficacy and safety of polaprezinc combined with triple therapy was compared with triple therapy alone in the eradication of Helicobacter pylori. A randomized, parallel-group, open-label, controlled, prospective multicenter study was conducted in 11 cities in China. Treatment-naive patients with H. pylori–associated gastritis were randomly assigned to one of three arms for a 14-day treatment: Arm A triple therapy (omeprazole 20 mg, amoxicillin 1 g, and clarithromycin 500 mg, each twice daily) plus polaprezinc 75 mg twice daily; Arm B triple therapy plus polaprezinc 150 mg twice daily, or Arm C triple therapy alone. The rate of H. pylori eradication was the primary endpoint. Secondary endpoints were symptom improvement and lower incidence of adverse events. 303 patients completed the study– 106, 96, and 101 patients in Arms A, B, and C, respectively. Intention-to-treat (ITT) analysis showed that the rate of H. pylori eradication was significantly higher for Arms A (77.0%) and B (75.9%) compared to Arm C (58.6%) (P < 0.01), whereas there was no difference between Arms A and B (P = 0.90). Per-protocol (PP) analysis showed that the rate of H. pylori eradication was significantly higher for Arms A (81.1%) and B (83.3%) compared to Arm C (61.4%) (P < 0.01), whereas there was no significant difference between Arms A and B (P = 0.62). All three groups reported significant symptom improvement at 7, 14, and 28 days after treatment, compared to baseline (P < 0.0001). The adverse event rate for Arm B (5.1%) was higher than for Arms A (2.8%) (P = 0.04) and C (1.9%) (P = 0.02). There were no serious adverse events in any group. It appears that standard dose polaprezinc combined with triple therapy can significantly improve the H. pylori eradication rate, without an increase in toxicity. [ABSTRACT FROM AUTHOR]

Objective Recurrence of Helicobacter pylori ( H. pylori) infection weakens the protective effect and long-term prognosis of eradication. With the widespread therapies, decreasing prevalence of H. pylori infection and improvement in living conditions, the recurrence of H. pylori infection may present with new features. We conducted this prospective, large-scale, multicenter follow-up study to determine the recurrence rate of H. pylori infection and its affecting factors. Methods A total of 827 patients receiving successful H. pylori eradication in our previous randomized controlled trial were enrolled. 13 C-urea breath test ( UBT) was repeated one year after the eradication therapy to determine its recurrence. Moreover, a questionnaire survey was performed to explore the potential factors affecting the recurrence. Results A total of 743 patients completed 13C- UBT (follow-up rate 89.8%), and the result was positive in 13 patients one year after eradication therapy, with an annual recurrence rate of 1.75% (95% confidence interval [ CI] 0.81-2.69%). Six hundred and ninety-two patients (13 with recurrence and 679 without recurrence) returned their questionnaires, with a response rate of >80%. Multivariate analysis revealed that peptic ulcer (odds ratio [ OR] 3.385, 95% CI 1.016-11.274), close contact with individuals having H. pylori infection ( OR 4.231, 95% CI 1.201-14.911), and hospitalization ( OR 9.302, 95% CI 2.441-35.440) were independent risk factors of H. pylori infection recurrence. Conclusions The recurrence of H. pylori infection one year after eradication therapy is low in urban population of China. Peptic ulcer, contact history with individuals having H. pylori infection and hospitalization are risk factors. [ABSTRACT FROM AUTHOR]

Background and study aims: Gastric intestinal metaplasia (GIM) is associated with a risk for development of intestinal-type gastric cancer. This study aimed to compare the diagnostic yield of GIM from confocal laser endomicroscopy (CLE) and white light endoscopy (WLE). Patients and methods: In a prospective, doubleblind, randomized study, patients were randomly assigned to receive either CLE with targeted biopsies (group A) or WLEwith a standard biopsy protocol (group B). Results: A total of 168 patients were finally analyzed (group A 85, group B 83). On a per-patient analysis, the diagnostic yields of GIM (including GIM with gastric intraepithelial neoplasia [GIN]) for groups A and B were 44.71% and 31.33%, respectively (P=0.074). On a per-biopsy analysis, CLE-targeted biopsy gave a significantly higher diagnostic yield of GIM compared with WLE and standard biopsy, at 65.70% (113/172 biopsies) versus 15.73% (81/515 biopsies) (P<0.001). Moreover, the diagnostic yield of the operative link on gastric intestinal metaplasia (OLGIM) assessment stages III and IV was higher at 20.93% (36/172 biopsies) in group A versus 4.08% (21 / 515 biopsies) in group B (P<0.001). In addition, use of CLE-guided biopsy significantly decreased by 68% (P<0.001) the mean number of biopsies required per patient. Conclusions: CLE with targeted biopsies is superior to WLE with standard biopsies for the detection and surveillance of GIM. The number of biopsies needed to confirm GIM is about one third of that needed with WLE with standard biopsies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Since the introduction of endoscopic retrograde cholangiopancreatology (ERCP) in clinical use, pancreatitis has become a common complication of ERCP. Octreotide is an inhibitor of pancreatic enzyme secretions. Several studies have evaluated the effect of octreotide on the incidence of clinical pancreatitis after ERCP, but with different results. The aim was to determine the efficacy of prophylactic administration of octreotide for the prevention of post-ERCP pancreatitis (PEP) and hyperamylasemia. METHODS: In this study, patients with scheduled ERCP were randomized to receive either octreotide (0.3 mg) via intramuscular injection or a placebo. The study was conducted in 12 digestive endoscopic units in China. Patients were randomized into two groups: an octreotide group (N = 414) and a control group (N = 418). In the octreotide group, octreotide (0.3 mg) was dissolved in 500 mL of 0.9% saline solution and administered by continuous intravenous infusion, beginning 1 h before endoscopic examination and continued for 6 h thereafter; 0.1 mg of octreotide was injected subcutaneously at 6 and 12 h after the intravenous injection was stopped. The control group was given a placebo intravenously. The end point was the development of acute pancreatitis. RESULTS: The overall incidence of acute pancreatitis was 3.85%; this included 2.42% (10/414) in the octreotide group and 5.26% (22/418) in the control group ( P= 0.046). The overall incidence of hyperamylasemia was 14.9%; 12.32% (51/414) in the octreotide group and 17.46% (73/418) in the control group ( P= 0.041). No side effects were found. CONCLUSION: The results indicate that octreotide can prevent PEP and hyperamylasemia. [ABSTRACT FROM AUTHOR]

Hydromorphone is an alternative to morphine for intrathecal drug delivery system to treat refractory cancer pain; however, there is not enough clinical evidence to prove it. In our study, 233 patients from 12 different pain management centers across China were enrolled, 121 and 112 in the intrathecal hydromorphone (ITHM) and intrathecal morphine (ITMO) groups, respectively. The primary outcome was the clinical success rate, which was defined as ratio of patients achieving ≥50% pain relief. The noninferiority margin was defined as -0.15. Other outcomes included daily visual analogue scale score, breakthrough pain (BTP) incidence, intrathecal dose change, and patient-controlled analgesia bolus count change, GAD-7/PHQ-9. Clinical success was achieved in 85 and 79 of the 121 ITHM patients (70.2%) and 112 ITMO patients (70.5%), respectively. Compared to the corresponding baseline findings, significantly decreased visual analogue scale scores and BTP incidence were noted in both groups. The dose change rate decreased and increased with time in the ITHM and ITMO groups, respectively (ITHM -3.33% vs ITMO 35.4%, P < 0.01, t test) from the third week. The patient-controlled analgesia bolus change rate was lower in the ITHM group than in the ITMO group (ITHM -19.88% vs ITMO 7.79%, P < 0.01, t test) from first week. Our result shows that ITHM is noninferior to ITMO on pain relief to treat refractory cancer pain, however, at different doses and that the doses of morphine tended to increase, whereas those of hydromorphone decreased over time. Hydromorphone offers advantage over morphine in controlling BTP. [ABSTRACT FROM AUTHOR]