Dear colleagues and friends,
For the second time, I am happy to comment the new EIO issue.
This issue features 6 studies on 6 very different topics and from different continents.
The first study is from UK and raises many questions, despite some limitations (single
center and retrospective study). It is a case-control study of patients with venous
thromboembolism (VTE). The risk to present with VTE is higher (O.R. 3.58) following
endoscopy than for the controls. When patients at risk for VTE are excluded, the risk
is the same with or without previous endoscopy. Causes to explain this higher risk
of VTE related to endoscopy could be dehydration, long-lasting fixed position or increased
intraabdominal pressure.
Endoscopic treatment has become over the years the standard treatment of ulcerative
gastrointestinal bleeding, but still failures are not uncommon and could lead to situations
which are difficult to manage. The study from Singapore and Hong-Kong is the first
meta-analysis comparing surgical arterial embolization treatment. The problem is that
comparative studies are few and retrospective. Conclusions of this meta-analysis should
be interpreted with caution, as the authors point out. Embolized patients were older
and had more comorbidities, but a post hoc sensitivity analysis did not show age or
comorbidities as confounding factors. Analysis of embolization is penalized by using
very different techniques in the different studies, and it seems that surgery still
plays a major role.
Another study from Osaka, Japan deals with ESD at the level of the esogastric junction.
The respective roles of ESD and EMR are still debated for cancers arising from Barrett’s
mucosa and ESD itself is challenging in this location, especially for non Asiatic
operators. This study is a plea for ESD due to the high R0 resection rates. Furthermore,
this study emphasizes the need to get a 1 cm safety lateral margin because of the
risk of submucosal lateral extension.
The fourth study (from the Netherlands) evaluated the role of a novel endoscopic bariatric
technique (duodeno-jejunal bypass liner) to induce remission of type 2 diabetes mellitus.
Twelve obese patients were followed-up 24 weeks after the liner placement. Significant
weight loss, decrease in fat mass, and early remission of type 2 diabetes, were observed
for bypass surgery. Accompanying gut hormone responses were also analyzed. Unexpected
increase in fasting ghrelin should be analysed further.
A meta-analysis has been conducted in the USA about the role of age on ERCP-related
side-effects. This paper, the first of this kind, shows that increasing age seems
to protect against post-ERCP pancreatitis and that ERCP is safe in the elderly when
it is defined by age > 65. However, above the age of 80 or 90, cardiopulmonary adverse
events (maybe explained by more severe comorbidities) and bleedings (maybe due to
more frequent medications, more frequent diverticulum or larger stones) are more frequently
observed and mortality increased by 2 to 4-fold.
The last paper is very appealing as it reports another application of the OTS clips.
These clips already changed the landscape of iatrogenic perforation as it is a very
effective rescue therapy in this case. In these series from the USA, OTS clips have
been used also as a rescue therapy for different acute severe upper GI bleeding in
case of failure of previous endoscopic treatment. The clips appear very effective.
More studies are needed first to observe some limits and to test the method also as
first line method.
Good reading and best regards,
Thierry Ponchon, MD
Editor-in-Chief, Endoscopy International Open