keyword
https://read.qxmd.com/read/35849399/feasibility-of-prospectively-comparing-opioid-analgesia-with-opioid-free-analgesia-after-outpatient-general-surgery-a-pilot-randomized-clinical-trial
#21
RANDOMIZED CONTROLLED TRIAL
Uyen Do, Charbel El-Kefraoui, Makena Pook, Saba Balvardi, Natasha Barone, Philip Nguyen-Powanda, Lawrence Lee, Gabriele Baldini, Liane S Feldman, Julio F Fiore, Mohsen Alhashemi, Alen Antoun, Jeffrey S Barkun, Krista M Brecht, Prosanto K Chaudhury, Dan Deckelbaum, Elise Di Lena, Sinziana Dumitra, Hiba Elhaj, Paola Fata, David Fleiszer, Gerald M Fried, Jeremy Grushka, Pepa Kaneva, Kosar Khwaja, Maxime Lapointe-Gagner, Katherine M McKendy, Ari N Meguerditchian, Sarkis H Meterissian, Haley Montgomery, Fateme Rajabiyazdi, Nadia Safa, Nawar Touma, Francine Tremblay
IMPORTANCE: The overprescription of opioids to surgical patients is recognized as an important factor contributing to the opioid crisis. However, the value of prescribing opioid analgesia (OA) vs opioid-free analgesia (OFA) after postoperative discharge remains uncertain. OBJECTIVE: To investigate the feasibility of conducting a full-scale randomized clinical trial (RCT) to assess the comparative effectiveness of OA vs OFA after outpatient general surgery. DESIGN, SETTING, AND PARTICIPANTS: This parallel, 2-group, assessor-blind, pragmatic pilot RCT was conducted from January 29 to September 3, 2020 (last follow-up on October 2, 2020)...
July 1, 2022: JAMA Network Open
https://read.qxmd.com/read/35785542/acg-cag-provided-suggestions-for-periendoscopic-management-of-anticoagulants-and-antiplatelets
#22
COMMENT
David R Lichtenstein, Neal D Dharmadhikari
Abraham NS, Barkun AN, Sauer BG, et al. American College of Gastroenterology-Canadian Association of Gastroenterology clinical practice guideline: management of anticoagulants and antiplatelets during acute gastrointestinal bleeding and the periendoscopic period. Am J Gastroenterol. 2022;117:542-58. 35297395.
July 2022: Annals of Internal Medicine
https://read.qxmd.com/read/35750082/endoscopic-ultrasound-guided-gastrojejunostomy-and-choledochoduodenostomy-with-lumen-apposing-metal-stents-an-efficient-approach-to-double-endoscopic-bypass
#23
JOURNAL ARTICLE
Abdulrahman Qatomah, Abrar Nawawi, Ali Bessissow, Jeffrey Barkun, Corey Miller, Yen-I Chen
No abstract text is available yet for this article.
June 24, 2022: Endoscopy
https://read.qxmd.com/read/35707910/review-obesity-and-colorectal-cancer
#24
REVIEW
Marc Bardou, Alexia Rouland, Myriam Martel, Romaric Loffroy, Alan N Barkun, Nicolas Chapelle
BACKGROUND: Obesity is a growing global public health problem. More than half the European and North American population is overweight or obese. Colon and rectum cancers are still the second leading cause of cancer death worldwide, and epidemiological data support an association between obesity and colorectal cancers (CRCs). AIM: To review the literature on CRC epidemiology in obese subjects, assessing the effects of obesity, including childhood or maternal obesity, on CRC, diagnosis, management, and prognosis, and discussing targeted prophylactic measures...
June 16, 2022: Alimentary Pharmacology & Therapeutics
https://read.qxmd.com/read/35668663/what-size-cutoff-level-should-be-used-to-implement-optical-polyp-diagnosis
#25
JOURNAL ARTICLE
Mahsa Taghiakbari, Heiko Pohl, Roupen Djinbachian, Joseph C Anderson, Danny Metellus, Alan N Barkun, Mickael Bouin, Daniel von Renteln
BACKGROUND : The risk of advanced pathology increases with polyp size, as does the potential for mismanagement when optical diagnosis is used. This study aimed to evaluate the proportion of patients who would be assigned inadequate surveillance intervals when different size cutoffs are adopted for use of optical diagnosis. METHODS : In a post hoc analysis of three prospective studies, the use of optical diagnosis was evaluated for three polyp size groups: 1-3, 1-5, and 1-10 mm. The primary outcome was the proportion of patients in whom advanced adenomas were found and optical diagnosis resulted in delayed surveillance...
June 3, 2022: Endoscopy
https://read.qxmd.com/read/35352550/in-vitro-evaluation-of-real-time-viscoelastic-and-coagulation-properties-of-various-classes-of-topical-hemostatic-agents-using-a-novel-contactless-nondestructive-technology
#26
JOURNAL ARTICLE
Ehsan Rezabeigi, Cédric Schmitt, Anis Hadj Henni, Alan N Barkun, Showan N Nazhat
Hemorrhaging is the main cause of death among combat and civilian injuries and has significant clinical and economic consequences. Despite their vital roles in bleeding management, an optimal topical hemostatic agent (HA) has yet to be developed for a particular scenario. This is partly due to a lack of an overarching quantitative testing technology to characterize the various classes of HAs in vitro. Herein, the feasibility of a novel, contactless, and nondestructive technique to quantitatively measure the shear storage modulus ( G ') and clotting properties of whole blood in contact with different dosages of eight topical HAs, including particulates and gauze-like and sponge-like systems, was assessed...
April 13, 2022: ACS Applied Materials & Interfaces
https://read.qxmd.com/read/35124074/use-of-topical-mineral-powder-as-monotherapy-for-treatment-of-active-peptic-ulcer-bleeding
#27
MULTICENTER STUDY
Joseph J Y Sung, Sulleman Moreea, Harinder Dhaliwal, Dana C Moffatt, Krish Ragunath, Terry Ponich, Alan N Barkun, Ernst J Kuipers, Robert Bailey, Fergal Donnellan, David Wagner, Keith Sanborn, James Lau
BACKGROUND AND AIMS: The aim of this study was to evaluate the safety and effectiveness of Hemospray (Cook Medical, Winston-Salem, NC, USA), a hemostatic powder, as monotherapy for active peptic ulcer bleeding. METHODS: In this prospective, multicenter, single-arm study, patients with Forrest Ia or Ib peptic ulcers underwent endoscopic application of Hemospray as treatment of first intent. Effectiveness endpoints were successful hemostasis at the end of the index endoscopy, recurrent bleeding within 72 hours and from 72 hours to 30 days, adverse events requiring reintervention or resulting in morbidity or mortality, and 30-day mortality...
July 2022: Gastrointestinal Endoscopy
https://read.qxmd.com/read/34804204/early-cholangioscopy-assisted-electrohydraulic-lithotripsy-in-difficult-biliary-stones-is-cost-effective
#28
JOURNAL ARTICLE
Saad Alrajhi, Alan Barkun, Viviane Adam, Kashi Callichurn, Myriam Martel, Olaya Brewer, Mouen A Khashab, Nauzer Forbes, Majid A Almadi, Yen-I Chen
BACKGROUND AND AIMS: Single-operator cholangioscopy-assisted electrohydraulic lithotripsy (SOC-EHL) is effective and safe in difficult choledocholithiasis. The optimal timing of SOC-EHL use, however, in refractory stones has not been elucidated. The following aims to determine the most cost-effective timing of SOC-EHL introduction in the management of choledocholithiasis. METHODS: A cost-effectiveness model was developed assessing three strategies with a progressively delayed introduction of SOC-EHL...
2021: Therapeutic Advances in Gastroenterology
https://read.qxmd.com/read/34714528/renin-angiotensin-aldosterone-system-inhibitors-and-risk-of-acute-pancreatitis-a-population-based-cohort-study
#29
JOURNAL ARTICLE
Julie Rouette, Hui Yin, Emily G McDonald, Alan Barkun, Laurent Azoulay
INTRODUCTION: There are conflicting reports on the effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) on acute pancreatitis incidence. OBJECTIVE: The aim was to determine whether use of ACE inhibitors and ARBs is associated with the incidence of acute pancreatitis, compared with use of dihydropyridine calcium channel blockers (dCCBs). METHODS: We assembled two population-based, new-user, active comparator cohorts using the United Kingdom Clinical Practice Research Datalink linked to the Hospital Episode Statistics repository and Office for National Statistics from 1998 to 2018, with follow-up until 2019...
January 2022: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
https://read.qxmd.com/read/34617004/predictors-of-malignancy-in-patients-with-indeterminate-biliary-strictures-and-atypical-biliary-cytology-results-from-retrospective-cohort-study
#30
JOURNAL ARTICLE
Ali Alali, Maria Moris, Myriam Martel, Catherine Streutker, Maria Cirocco, Jeffrey Mosko, Paul Kortan, Alan Barkun, Gary R May
Background: Atypical cellular features are commonly encountered in patients with indeterminate biliary strictures, which are nondiagnostic of malignancy yet cannot rule it out. This study aims to identify clinical features that could discriminate patients with indeterminate biliary strictures and atypical biliary cytology who may harbor underlying malignancy. Methods: All patients with an indeterminate biliary stricture and an atypical brush cytology obtained during endoscopic brushings were identified in a large tertiary-care center...
October 2021: Journal of the Canadian Association of Gastroenterology
https://read.qxmd.com/read/34556502/oncology-clinic-based-germline-genetic-testing-for-exocrine-pancreatic-cancer-enables-timely-return-of-results-and-unveils-low-uptake-of-cascade-testing
#31
JOURNAL ARTICLE
Yifan Wang, Bryn Golesworthy, Adeline Cuggia, Celine Domecq, Prosanto Chaudhury, Jeffrey Barkun, Peter Metrakos, Jamil Asselah, Nathaniel Bouganim, Zu-Hua Gao, George Chong, William D Foulkes, George Zogopoulos
BACKGROUND: Traditional medical genetics models are unable to meet the growing demand for germline genetic testing (GT) in patients with exocrine pancreatic cancer (PC). This study investigates the impact of an ambulatory oncology clinic-based GT model. METHODS: From 2012 to 2021, patients with PC were prospectively enrolled and considered for GT. Two chronological cohorts were compared: (1) the preuniversal genetic testing (pre-UGT) cohort, which received GT based on clinical criteria or family history; and (2) the post-UGT cohort, where an 86-gene panel was offered to all patients with PC...
September 23, 2021: Journal of Medical Genetics
https://read.qxmd.com/read/34226290/proton-pump-inhibitors-and-risk-of-gastric-cancer-population-based-cohort-study
#32
COMPARATIVE STUDY
Devin Abrahami, Emily Gibson McDonald, Mireille E Schnitzer, Alan N Barkun, Samy Suissa, Laurent Azoulay
OBJECTIVE: To determine whether new users of proton pump inhibitors (PPIs) are at an increased risk of gastric cancer compared with new users of histamine-2 receptor antagonists (H2RAs). DESIGN: Using the UK Clinical Practice Research Datalink, we conducted a population-based cohort study using a new-user active comparator design. From 1 January 1990 to 30 April 2018, we identified 973 281 new users of PPIs and 193 306 new users of H2RAs. Cox proportional hazards models were fit to estimate HRs and 95% CIs of gastric cancer, and the number needed to harm was estimated using the Kaplan-Meier method...
January 2022: Gut
https://read.qxmd.com/read/34210775/proton-pump-inhibitors-and-risk-of-colorectal-cancer
#33
COMPARATIVE STUDY
Devin Abrahami, Emily Gibson McDonald, Mireille E Schnitzer, Alan N Barkun, Samy Suissa, Laurent Azoulay
OBJECTIVE: To determine whether proton pump inhibitors (PPIs) are associated with an increased risk of colorectal cancer, compared with histamine-2 receptor antagonists (H2RAs). DESIGN: The United Kingdom Clinical Practice Research Datalink was used to identify initiators of PPIs and H2RA from 1990 to 2018, with follow-up until 2019. Cox proportional hazards models were fit to estimate marginal HRs and 95% CIs of colorectal cancer. The models were weighted using standardised mortality ratio weights using calendar time-specific propensity scores...
January 2022: Gut
https://read.qxmd.com/read/33655049/checklist-feasibility-and-impact-in-gastrointestinal-endoscopy-a-systematic-review-and-narrative-synthesis
#34
REVIEW
Véronique Bitar, Myriam Martel, Sophie Restellini, Alan Barkun, Omar Kherad
Background and study aim  Checklists prevent errors and have a positive impact on patient morbidity and mortality in surgical settings. Despite increasing use of checklists in gastrointestinal endoscopy units across many countries, a summary of cumulated experience is lacking. The aim of this study was to identify and evaluate the feasibility of successful checklist implementation in gastrointestinal endoscopy units and summarise the evidence of its impact on the commitment in safety culture. Methods  A comprehensive literature search was performed identifying the use of a checklist or time-out in endoscopy units from 1978 to January 2020 using OVID MEDLINE, EMBASE, and ISI Web of Knowledge databases, with search terms related to checklist and endoscopy...
March 2021: Endoscopy International Open
https://read.qxmd.com/read/33649044/towards-personalised-management-for-non-variceal-upper-gastrointestinal-bleeding
#35
REVIEW
Joseph J Y Sung, Loren Laine, Ernst J Kuipers, Alan N Barkun
Guidelines from national and international professional societies on upper gastrointestinal bleeding highlight the important clinical issues but do not always identify specific management strategies pertaining to individual patients. Optimal treatment should consider the personal needs of an individual patient and the pertinent resources and experience available at the point of care. This article integrates international guidelines and consensus into three stages of management: pre-endoscopic assessment and treatment, endoscopic evaluation and haemostasis and postendoscopic management...
May 2021: Gut
https://read.qxmd.com/read/33592629/modified-eus-guided-double-balloon-occluded-gastroenterostomy-bypass-m-epass-a-pilot-study
#36
JOURNAL ARTICLE
Amanda Marino, Ali Bessissow, Corey S Miller, David Valenti, Louis M Boucher, Prosanto Chaudhury, Jeffrey Barkun, Nauzer Forbes, Mouen A Khashab, Josee Parent, Kevin Waschke, Myriam Martel, Yen-I Chen
Introduction We recently developed a double balloon device (DBD), using widely available existing technology, to facilitate EUS-gastroenterostomy. Our aim is to assess the feasibility of this modified approach to EUS-guided double-balloon-occluded gastroenterostomy bypass (M-EPASS). Methods Single-centre, retrospective study of consecutive patients undergoing M-EPASS from January 2019-August 2020. The DBD consists of two vascular balloons that optimizes the distention of a targeted small bowel segment for EUS-guided stent insertion...
February 16, 2021: Endoscopy
https://read.qxmd.com/read/33010414/association-between-time-to-colonoscopy-after-positive-fecal-testing-and-colorectal-cancer-outcomes-a-systematic-review
#37
REVIEW
Nauzer Forbes, Robert J Hilsden, Myriam Martel, Yibing Ruan, Catherine Dube, Alaa Rostom, Risa Shorr, Charles Menard, Darren R Brenner, Alan N Barkun, Steven J Heitman
BACKGROUND & AIMS: Colonoscopy is required following a positive fecal screening test for colorectal cancer (CRC). It remains unclear to what extent time to colonoscopy is associated with CRC-related outcomes. We performed a systematic review to elucidate this relationship. METHODS: An electronic search was performed through April 2020 for studies reporting associations between time from positive fecal testing to colonoscopy and outcomes including CRC incidence (primary outcome), CRC stage at diagnosis, and/or CRC-specific mortality...
July 2021: Clinical Gastroenterology and Hepatology
https://read.qxmd.com/read/32989022/recent-advances-in-clinical-practice-colorectal-cancer-chemoprevention-in-the-average-risk-population
#38
JOURNAL ARTICLE
Nicolas Chapelle, Myriam Martel, Esther Toes-Zoutendijk, Alan N Barkun, Marc Bardou
Colorectal cancer (CRC) is one of the most common and lethal malignancies in Western countries. Its development is a multistep process that spans more than 15 years, thereby providing an opportunity for prevention and early detection. The high incidence and mortality rates emphasise the need for prevention and screening. Many countries have therefore introduced CRC screening programmes. It is expected, and preliminary evidence in some countries suggests, that this screening effort will decrease CRC-related mortality rates...
December 2020: Gut
https://read.qxmd.com/read/32909973/personal-protective-equipment-for-endoscopy-in-low-resource-settings-during-the-covid-19-pandemic-guidance-from-the-world-gastroenterology-organisation
#39
JOURNAL ARTICLE
Desmond Leddin, David Armstrong, Raja A Raja Ali, Alan Barkun, Amna S Butt, Ye Chen, Harshit S Khara, Yeong Yeh Lee, Wai Keung Leung, Finlay Macrae, Govind Makharia, Reza Malekzadeh, Elias Makhoul, Anahita Sadeghi, Jean-Christophe Saurin, Mark Topazian, Sandie R Thomson, Andrew Veitch, Kaichun Wu
Performance of endoscopic procedures is associated with a risk of infection from COVID-19. This risk can be reduced by the use of personal protective equipment (PPE). However, shortage of PPE has emerged as an important issue in managing the pandemic in both traditionally high and low-resource areas. A group of clinicians and researchers from thirteen countries representing low, middle, and high-income areas has developed recommendations for optimal utilization of PPE before, during, and after gastrointestinal endoscopy with particular reference to low-resource situations...
September 8, 2020: Journal of Clinical Gastroenterology
https://read.qxmd.com/read/32905048/canadian-association-of-gastroenterology-communique-after-hours-endoscopy-cart
#40
JOURNAL ARTICLE
Mandip Rai, Mary Cooper, Scott Shulman, Dan Kottachchi, Sandra Nelles, Mark Macmillan, Steven Heitman, Alan Barkun, Frances Tse, Lawrence Hookey
Background: Endoscopic procedures performed after-hours often require therapeutic interventions that are technically demanding for the endoscopist. The aim of this position paper is to provide guidance on the minimum standard of equipment that should be available on a mobile endoscopy cart for provision of a safe and effective after-hours emergency endoscopy service. The guidance is based on consensus among academic and community gastroenterologists in Canada. Methods: A modified Delphi process was used to establish consensus among 9 participants...
October 2020: Journal of the Canadian Association of Gastroenterology
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