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Article ; Online: Modeling the influence of attitudes, trust, and beliefs on endoscopists' acceptance of artificial intelligence applications in medical practice.

Schulz, Peter J / Lwin, May O / Kee, Kalya M / Goh, Wilson W B / Lam, Thomas Y T / Sung, Joseph J Y

2023 Volume 11, Page(s) 1301563

Abstract: Introduction: The potential for deployment of Artificial Intelligence (AI) technologies in various fields of medicine is vast, yet acceptance of AI amongst clinicians has been patchy. This research therefore examines the role of antecedents, namely ... ...

Abstract	Introduction: The potential for deployment of Artificial Intelligence (AI) technologies in various fields of medicine is vast, yet acceptance of AI amongst clinicians has been patchy. This research therefore examines the role of antecedents, namely trust, attitude, and beliefs in driving AI acceptance in clinical practice. Methods: We utilized online surveys to gather data from clinicians in the field of gastroenterology. Results: A total of 164 participants responded to the survey. Participants had a mean age of 44.49 (SD = 9.65). Most participants were male ( Discussion: The role of trust and beliefs as primary mediators of the acceptance of AI in medical practice suggest that these should be areas of focus in AI education, engagement and training. This has implications for how AI systems can gain greater clinician acceptance to engender greater trust and adoption amongst public health systems and professional networks which in turn would impact how populations interface with AI. Implications for policy and practice, as well as future research in this nascent field, are discussed.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Artificial Intelligence ; Educational Status ; Policy ; Technology ; Trust ; Gastroenterology ; Endoscopy
Language	English
Publishing date	2023-11-28
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1301563
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Article ; Online: Randomized Controlled Trials of Artificial Intelligence in Clinical Practice: Systematic Review.

Lam, Thomas Y T / Cheung, Max F K / Munro, Yasmin L / Lim, Kong Meng / Shung, Dennis / Sung, Joseph J Y

Journal of medical Internet research

2022 Volume 24, Issue 8, Page(s) e37188

Abstract: Background: The number of artificial intelligence (AI) studies in medicine has exponentially increased recently. However, there is no clear quantification of the clinical benefits of implementing AI-assisted tools in patient care.: Objective: This ... ...

Abstract	Background: The number of artificial intelligence (AI) studies in medicine has exponentially increased recently. However, there is no clear quantification of the clinical benefits of implementing AI-assisted tools in patient care. Objective: This study aims to systematically review all published randomized controlled trials (RCTs) of AI-assisted tools to characterize their performance in clinical practice. Methods: CINAHL, Cochrane Central, Embase, MEDLINE, and PubMed were searched to identify relevant RCTs published up to July 2021 and comparing the performance of AI-assisted tools with conventional clinical management without AI assistance. We evaluated the primary end points of each study to determine their clinical relevance. This systematic review was conducted following the updated PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Results: Among the 11,839 articles retrieved, only 39 (0.33%) RCTs were included. These RCTs were conducted in an approximately equal distribution from North America, Europe, and Asia. AI-assisted tools were implemented in 13 different clinical specialties. Most RCTs were published in the field of gastroenterology, with 15 studies on AI-assisted endoscopy. Most RCTs studied biosignal-based AI-assisted tools, and a minority of RCTs studied AI-assisted tools drawn from clinical data. In 77% (30/39) of the RCTs, AI-assisted interventions outperformed usual clinical care, and clinically relevant outcomes improved with AI-assisted intervention in 70% (21/30) of the studies. Small sample size and single-center design limited the generalizability of these studies. Conclusions: There is growing evidence supporting the implementation of AI-assisted tools in daily clinical practice; however, the number of available RCTs is limited and heterogeneous. More RCTs of AI-assisted tools integrated into clinical practice are needed to advance the role of AI in medicine. Trial registration: PROSPERO CRD42021286539; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286539.
MeSH term(s)	Artificial Intelligence ; Europe ; Humans ; North America ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2022-08-25
Publishing country	Canada
Document type	Journal Article ; Review ; Systematic Review
ZDB-ID	2028830-X
ISSN	1438-8871 ; 1438-8871
ISSN (online)	1438-8871
ISSN	1438-8871
DOI	10.2196/37188
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Article ; Online: Nurse-led reinforced education by mobile messenger improves the quality of bowel preparation of colonoscopy in a population-based colorectal cancer screening program: A randomized controlled trial.

Lam, Thomas Y T / Wu, Peter I / Tang, Raymond S Y / Tse, Y K / Lau, James Y W / Wu, Justin C Y / Sung, Joseph J Y

International journal of nursing studies

2022 Volume 133, Page(s) 104301

Abstract: Background: Adequate bowel preparation is an important colonoscopy quality indicator. Reinforced education is effective in improving bowel preparation quality of colonoscopy with mixed indications. However, it remains unclear whether such improvement ... ...

Abstract	Background: Adequate bowel preparation is an important colonoscopy quality indicator. Reinforced education is effective in improving bowel preparation quality of colonoscopy with mixed indications. However, it remains unclear whether such improvement can be consistently observed in pre- and post-irrigation during colonoscopy in screening population. Objective: We aimed to study the effectiveness of nurse-led reinforced education delivered via mobile messenger (WhatsApp Messenger) on pre- and post-irrigation bowel preparation adequacy in colonoscopies for positive fecal immunochemical test in a population-based colorectal cancer screening program. Design: Randomized controlled trial. Setting: A hospital-based endoscopy centre in Hong Kong, China. Participants: Patients undergoing colonoscopy for positive fecal immunochemical test in a population-based colorectal cancer screening program. Methods: The recruited patients were randomized to receive either WhatsApp Reinforced Education (WRE) or No Reinforced Education (NRE) (1:1). Patients in WRE group received one-off reinforced education of bowel preparation in text and video formats via WhatsApp Messenger four days prior to colonoscopy sent by investigator while NRE group received standard-of-care only. Primary outcome was the bowel preparation adequacy rate as evaluated by Aronchick Scale. Secondary outcomes included bowel preparation adequacy rate as evaluated by Boston Bowel Preparation Scale, adenoma detection rate and risk factors of bowel preparation inadequacy. Continuous variables were described as means with standard deviation (SD) and analyzed with Student's t-test. The Pearson Chi Square Test or Fisher Exact Test was used to assess categorical variables when appropriate. Risk factors were determined by logistic regression. Results: From July 2017 to April 2019, 685 eligible patients were randomized to WRE (n = 343) and NRE (n = 342) groups. Patients in WRE group had higher bowel preparation adequacy rate as evaluated by Aronchik Scale (83.4% vs 75.4%, p = 0.010) and Boston Bowel Preparation Scale (94.2% vs 88.9%, p = 0.013). Adenoma detection rate was higher in WRE group but without statistical significance (71.4% vs 67.5%, p = 0.27). In logistic regression, WhatsApp Reinforced Education reduced the inadequate bowel preparation risk (Adjusted odds ratio: 0.564; 95% confidence interval: 0.371-0.856, p = 0.007). Male gender (Adjusted odds ratio [AOR]: 1.638; 95% confidence interval [CI]: 1.054-2.546, p = 0.028) and diabetes (AOR: 2.062; 95% CI: 1.215-3.497, p = 0.007) were risk factors of bowel preparation inadequacy. Conclusions: Nurse-led mobile messenger-initiated reinforced education improves both pre- and post-irrigation bowel preparation quality of screening colonoscopy following positive fecal immunochemical test. It is readily incorporable in clinical practice because of its low setup cost. Registration number: Registered on 4 July 2017 on https://clinicaltrials.gov/ (NCT03209739).
MeSH term(s)	Adenoma/chemically induced ; Adenoma/diagnosis ; Adenoma/drug therapy ; Cathartics/adverse effects ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; Early Detection of Cancer ; Humans ; Male ; Nurse's Role
Chemical Substances	Cathartics
Language	English
Publishing date	2022-05-30
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	80148-3
ISSN	1873-491X ; 0020-7489
ISSN (online)	1873-491X
ISSN	0020-7489
DOI	10.1016/j.ijnurstu.2022.104301
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Article ; Online: Altered gut microbiota of obesity subjects promotes colorectal carcinogenesis in mice.

Kang, Xing / Ng, Siu-Kin / Liu, Changan / Lin, Yufeng / Zhou, Yunfei / Kwong, Thomas N Y / Ni, Yunbi / Lam, Thomas Y T / Wu, William K K / Wei, Hong / Sung, Joseph J Y / Yu, Jun / Wong, Sunny H

EBioMedicine

2023 Volume 93, Page(s) 104670

Abstract: Background: Obesity is a risk factor for colorectal cancer (CRC). The role of gut microbiota in mediating the cancer-promoting effect of obesity is unknown.: Methods: Azoxymethane (AOM)-treated, Apc: Findings: Conventional AOM-treated and Apc: ... ...

Abstract	Background: Obesity is a risk factor for colorectal cancer (CRC). The role of gut microbiota in mediating the cancer-promoting effect of obesity is unknown. Methods: Azoxymethane (AOM)-treated, Apc Findings: Conventional AOM-treated and Apc Interpretation: Our results supported the role of obesity-associated microbiota in colorectal carcinogenesis and identified putative bacterial candidates that may mediate its mechanisms. Microbiota modulation in obese individuals may provide new approaches to prevent or treat obesity-related cancers including CRC. Funding: This work was funded by National Key Research and Development Program of China (2020YFA0509200/2020YFA0509203), National Natural Science Foundation of China (81922082), RGC Theme-based Research Scheme Hong Kong (T21-705/20-N), RGC Research Impact Fund Hong Kong (R4632-21F), RGC-CRF Hong Kong (C4039-19GF and C7065-18GF), RGC-GRF Hong Kong (14110819, 14111621), and NTU Start-Up Grant (021337-00001).
MeSH term(s)	Humans ; Mice ; Animals ; Gastrointestinal Microbiome ; Colonic Neoplasms ; Carcinogenesis ; Obesity/complications ; Azoxymethane/toxicity ; Colorectal Neoplasms/genetics ; Mice, Inbred C57BL ; Disease Models, Animal
Chemical Substances	Azoxymethane (MO0N1J0SEN)
Language	English
Publishing date	2023-06-19
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2851331-9
ISSN	2352-3964
ISSN (online)	2352-3964
DOI	10.1016/j.ebiom.2023.104670
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Article ; Online: Prevalence and risk factors for sessile serrated lesions in an average risk colorectal cancer screening population.

Lui, Rashid N / Kyaw, Moe H / Lam, Thomas Y T / Ching, Jessica Y L / Chan, Victor C W / Wong, Martin C S / Sung, Joseph J Y

Journal of gastroenterology and hepatology

2021 Volume 36, Issue 6, Page(s) 1656–1662

Abstract: Background and aim: The reported prevalence and risk factors for sessile serrated lesions (SSLs) show significant variation. We aimed to specifically study the prevalence and potential risk factors of SSLs in an average risk colorectal cancer (CRC) ... ...

Abstract	Background and aim: The reported prevalence and risk factors for sessile serrated lesions (SSLs) show significant variation. We aimed to specifically study the prevalence and potential risk factors of SSLs in an average risk colorectal cancer (CRC) screening population of Chinese subjects. Methods: This is a case-control study of prospectively collected data from a territory-wide colorectal screening program in Hong Kong. Information on risk factors was obtained from questionnaires completed prior to screening colonoscopy. We compared subjects with SSLs against controls without these lesions to identify potential risk factors using multivariable logistic regression. Results: Of 12 039 asymptomatic screening subjects, 6011 subjects received a screening colonoscopy with 2214 subjects (36.8%) having conventional adenomas, 486 subjects (8.1%) having hyperplastic polyps, and 85 subjects (1.4%) having SSLs only. Of these subjects, three had synchronous advanced adenomas and were excluded from the analysis. More than 60% of these lesions were in the proximal colon. We compared these 82 subjects with SSLs only and 3226 controls without any polyps. After multivariable logistic regression, age ≥ 66 years, smoking, and diabetes mellitus (DM) were significant independent risk factors for SSLs. Conclusion: In this study, we report the prevalence of SSLs to be 1.4%. Age ≥ 66 years, smoking, and DM were independent risk factors for these lesions. Our findings provide relevant new data that should be taken into consideration when designing region-specific surveillance programs for SSLs with the ultimate goal of reducing the risk of CRC.
MeSH term(s)	Adenoma/diagnosis ; Adenoma/epidemiology ; Adenoma/etiology ; Adenoma/prevention & control ; Aged ; Asian Continental Ancestry Group ; Case-Control Studies ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/epidemiology ; Colorectal Neoplasms/etiology ; Colorectal Neoplasms/prevention & control ; Diabetes Mellitus ; Early Detection of Cancer ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Smoking/adverse effects
Language	English
Publishing date	2021-01-06
Publishing country	Australia
Document type	Journal Article
ZDB-ID	632882-9
ISSN	1440-1746 ; 0815-9319
ISSN (online)	1440-1746
ISSN	0815-9319
DOI	10.1111/jgh.15368
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Article ; Online: Mobile messenger-initiated reminders improve longitudinal adherence in a community-based, opportunistic colorectal cancer screening program: A single-blind, crossover randomized controlled study.

Lam, Thomas Y T / Wu, Peter I / Tang, Raymond S Y / Luk, Arthur K C / Ng, Simpson / Sung, Joseph J Y

Cancer

2020 Volume 127, Issue 6, Page(s) 914–921

Abstract: Background: The fecal immunochemical test (FIT) is a cost-effective colorectal cancer (CRC) screening tool. However, longitudinal adherence, a factor that is critical to the success to any FIT-based screening program, often is poor. The authors ... ...

Abstract	Background: The fecal immunochemical test (FIT) is a cost-effective colorectal cancer (CRC) screening tool. However, longitudinal adherence, a factor that is critical to the success to any FIT-based screening program, often is poor. The authors hypothesized that reminders sent via mobile messengers, such as WhatsApp, improve such adherence. Methods: In the current single-blind, randomized study, subjects from an opportunistic FIT screening program who had a negative FIT result the year prior were randomly allocated (1:1) to receive either a 1-off reminder via the WhatsApp messenger (WR) 1 month prior to the due appointments or no reminder (NR). All subjects were blinded to study participation and group allocation. At 24 months after randomization, a crossover of intervention was performed among those individuals who remained in the FIT program. The primary outcome was FIT adherence, defined as the pick-up and on-time return of the FIT. The secondary outcome was FIT adherence after the crossover. Results: A total of 500 subjects were randomized to receive WR (250 subjects) or NR (250 subjects). Three individuals were excluded from analysis (1 died and 2 underwent colonoscopy). Both the FIT pick-up rate (80.3% vs 59.3%; P < .001) and return rate (79.9% vs 57.3%; P < .001) were significantly higher in the WR group compared with the NR group. After crossover of intervention (452 subjects), the WR group again was found to have a higher FIT pick-up rate (79.1% vs 52.9%; P < .001) and return rate (78.2% vs 52.4%; P < .001). Conclusions: Text reminders sent via mobile messenger appear to improve the longitudinal adherence to FIT-based opportunistic CRC screening programs. The routine use of this technology in CRC screening should be considered.
MeSH term(s)	Aged ; Colorectal Neoplasms/diagnosis ; Cross-Over Studies ; Early Detection of Cancer/methods ; Female ; Humans ; Male ; Middle Aged ; Occult Blood ; Patient Compliance ; Single-Blind Method ; Text Messaging
Language	English
Publishing date	2020-11-20
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	1429-1
ISSN	1097-0142 ; 0008-543X ; 1934-662X
ISSN (online)	1097-0142
ISSN	0008-543X ; 1934-662X
DOI	10.1002/cncr.33336
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Article ; Online: Stress Hyperglycemia Is Associated With an Increased Risk of Subsequent Development of Diabetes Among Bacteremic and Nonbacteremic Patients.

Wang, Xiansong / Cheng, Frankie T F / Lam, Thomas Y T / Liu, Yingzhi / Huang, Dan / Liu, Xiaodong / Chen, Huarong / Zhang, Lin / Ali, Yusuf / Wang, Maggie H T / Yu, Jun / Gin, Tony / Chan, Matthew T V / Wu, William K K / Wong, Sunny H

Diabetes care

2022 Volume 45, Issue 6, Page(s) 1438–1444

Abstract: Objective: Stress hyperglycemia is associated with an increased risk of diabetes among survivors of critical illness. We investigated whether patients without diabetes hospitalized for bacteremia or nonbacteremic diseases with transient stress ... ...

Abstract	Objective: Stress hyperglycemia is associated with an increased risk of diabetes among survivors of critical illness. We investigated whether patients without diabetes hospitalized for bacteremia or nonbacteremic diseases with transient stress hyperglycemia would have a higher risk of subsequent diabetes development compared with those who remained normoglycemic. Research design and methods: This retrospective observational study was conducted on 224,534 in-patients with blood culture records. Stress hyperglycemia was defined based on the highest random glucose level ≥7.8 mmol/L during the index admission period. Diagnosis of diabetes, as the primary end point of interest, was defined based on diagnostic codes, blood test results, or medication records. Differences in cumulative incidence and hazard ratios (HRs) of diabetes between groups were assessed using the Kaplan-Meier estimator and Cox regression. Results: After exclusion of patients with preexisting or undiagnosed diabetes or indeterminate diabetes status and propensity score matching, bacteremic patients with stress hyperglycemia had a significantly higher cumulative incidence of diabetes (HR 1.7, 95% CI 1.2-2.4) compared with those who remained normoglycemic. Stress hyperglycemia was further confirmed to be a diabetes predictor independent of age, sex, comorbidity, and other serological markers. For the nonbacteremic patients, stress hyperglycemia was similarly associated with a higher cumulative incidence of diabetes (HR 1.4, 95% CI 1.2-1.7). Conclusions: Hospitalized patients with transient stress hyperglycemia had a higher risk of subsequent diabetes development compared with their normoglycemic counterparts. Recognition of an increased risk of diabetes in these patients can allow early detection and monitoring in their subsequent follow-ups.
MeSH term(s)	Bacteremia/complications ; Bacteremia/epidemiology ; Blood Glucose ; Diabetes Mellitus/epidemiology ; Hospitalization ; Humans ; Hyperglycemia/complications ; Hyperglycemia/epidemiology ; Retrospective Studies
Chemical Substances	Blood Glucose
Language	English
Publishing date	2022-03-11
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	441231-x
ISSN	1935-5548 ; 0149-5992
ISSN (online)	1935-5548
ISSN	0149-5992
DOI	10.2337/dc21-1682
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Zs.A 1434: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Impact of COVID-19 infection and vaccination in pancreatobiliary IgG4-related disease patients: An international multicenter study.

Journal of gastroenterology and hepatology

2023 Volume 38, Issue 4, Page(s) 584–589

Abstract: Background and aim: Dedicated studies evaluating the impact of COVID-19 on outcomes of pancreatobiliary IgG4 related disease (IgG4-RD) patients are scarce. Whether COVID-19 infection or vaccination would trigger IgG4-RD exacerbation remains unknown.: ... ...

Abstract	Background and aim: Dedicated studies evaluating the impact of COVID-19 on outcomes of pancreatobiliary IgG4 related disease (IgG4-RD) patients are scarce. Whether COVID-19 infection or vaccination would trigger IgG4-RD exacerbation remains unknown. Methods: Pancreatobiliary IgG4-RD patients ≥ 18 years old with active follow-up since January 2020 from nine referral centers in Asia, Europe, and North America were included in this multicenter retrospective study. Outcome measures include incidence and severity of COVID-19 infection, IgG4-RD disease activity and treatment status, interruption of indicated IgG4-RD treatment. Prospective data on COVID-19 vaccination status and new COVID-19 infection during the Omicron outbreak were also retrieved in the Hong Kong cohort. Results: Of the 124 pancreatobiliary IgG4-RD patients, 25.0% had active IgG4-RD, 71.0% were on immunosuppressive therapies and 80.6% had ≥ 1 risk factor for severe COVID. In 2020 (pre-vaccination period), two patients (1.6%) had COVID-19 infection (one requiring ICU admission), and 7.2% of patients had interruptions in indicated immunosuppressive treatment for IgG4-RD. Despite a high vaccination rate (85.0%), COVID-19 infection rate has increased to 20.0% during Omicron outbreak in the Hong Kong cohort. A trend towards higher COVID-19 infection rate was noted in the non-fully vaccinated/unvaccinated group (17.6% vs 33.3%, P = 0.376). No IgG4-RD exacerbation following COVID-19 vaccination or infection was observed. Conclusion: While a low COVID-19 infection rate with no mortality was observed in pancreatobiliary IgG4-RD patients in the pre-vaccination period of COVID-19, infection rate has increased during the Omicron outbreak despite a high vaccination rate. No IgG4-RD exacerbation after COVID-19 infection or vaccination was observed.
MeSH term(s)	Humans ; Adolescent ; Immunoglobulin G4-Related Disease ; Retrospective Studies ; COVID-19/epidemiology ; COVID-19/prevention & control ; COVID-19 Vaccines ; Prospective Studies ; Immunoglobulin G ; Vaccination ; Hong Kong/epidemiology
Chemical Substances	COVID-19 Vaccines ; Immunoglobulin G
Language	English
Publishing date	2023-01-06
Publishing country	Australia
Document type	Multicenter Study ; Journal Article
ZDB-ID	632882-9
ISSN	1440-1746 ; 0815-9319
ISSN (online)	1440-1746
ISSN	0815-9319
DOI	10.1111/jgh.16100
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Article ; Online: A modified colorectal screening score for prediction of advanced neoplasia: A prospective study of 5744 subjects.

Sung, Joseph J Y / Wong, Martin C S / Lam, Thomas Y T / Tsoi, Kelvin K F / Chan, Victor C W / Cheung, Wilson / Ching, Jessica Y L

Journal of gastroenterology and hepatology

2018 Volume 33, Issue 1, Page(s) 187–194

Abstract: Background and aim: We validated a modified risk algorithm based on the Asia-Pacific Colorectal Screening (APCS) score that included body mass index (BMI) for prediction of advanced neoplasia.: Methods: Among 5744 Chinese asymptomatic screening ... ...

Abstract	Background and aim: We validated a modified risk algorithm based on the Asia-Pacific Colorectal Screening (APCS) score that included body mass index (BMI) for prediction of advanced neoplasia. Methods: Among 5744 Chinese asymptomatic screening participants undergoing a colonoscopy in Hong Kong from 2008 to 2012, a random sample of 3829 participants acted as the derivation cohort. The odds ratios for significant risk factors identified by binary logistic regression analysis were used to build a scoring system ranging from 0 to 6, divided into "average risk" (AR): 0; "moderate risk" (MR): 1-2; and "high risk" (HR): 3-6. The other 1915 subjects formed a validation cohort, and the performance of the score was assessed. Results: The prevalence of advanced neoplasia in the derivation and validation cohorts was 5.4% and 6.0%, respectively (P = 0.395). Old age, male gender, family history of colorectal cancer, smoking, and BMI were significant predictors in multivariate regression analysis. A BMI cut-off at > 23 kg/m Conclusions: Incorporating BMI into the predictors of APCS score was found to improve risk prediction of advanced neoplasia and reduce colonoscopy resources.
MeSH term(s)	Body Mass Index ; Cohort Studies ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/epidemiology ; Colorectal Neoplasms/etiology ; Colorectal Neoplasms/prevention & control ; Early Detection of Cancer ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Predictive Value of Tests ; Prevalence ; Prospective Studies ; Risk ; Risk Factors
Language	English
Publishing date	2018-01
Publishing country	Australia
Document type	Journal Article
ZDB-ID	632882-9
ISSN	1440-1746 ; 0815-9319
ISSN (online)	1440-1746
ISSN	0815-9319
DOI	10.1111/jgh.13835
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Article ; Online: Endoscopic ultrasound-guided cyanoacrylate injection to prevent rebleeding in hepatocellular carcinoma patients with variceal hemorrhage.

Tang, Raymond S Y / Kyaw, Moe H / Teoh, Anthony Y B / Lui, Rashid N S / Tse, Yee-Kit / Lam, Thomas Y T / Chan, Stephen L / Wong, Vincent W S / Wu, Justin C Y / Lau, James Y W / Sung, Joseph J Y

Journal of gastroenterology and hepatology

2020 Volume 35, Issue 12, Page(s) 2192–2201

Abstract: Background and aim: Secondary prophylaxis (SP) of variceal rebleeding was reported to improve outcomes of hepatocellular carcinoma (HCC) patients, but the optimal endoscopic approach is not well defined. We compared outcomes in HCC patients who ... ...

Abstract	Background and aim: Secondary prophylaxis (SP) of variceal rebleeding was reported to improve outcomes of hepatocellular carcinoma (HCC) patients, but the optimal endoscopic approach is not well defined. We compared outcomes in HCC patients who underwent SP by endoscopic ultrasound-guided cyanoacrylate obturation (EUS-CYA) versus no SP. Methods: Between 2014 and 2018, 30 consecutive patients with inoperable HCC and recent endoscopically controlled variceal bleeding were prospectively recruited. Twenty-seven patients with persistent varices ≥ 3 mm on endoscopic ultrasound underwent EUS-CYA for SP. Thirty-three HCC patients treated by esophagogastroduodenoscopy-guided CYA obturation (EGD-CYA) alone for acute variceal bleeding between 2009 and 2013 were identified from a prospective gastrointestinal bleed registry as standard of care controls for comparison. Outcome measures were death-adjusted cumulative incidence of rebleeding, bleeding-free survival, technical success, and procedure-related adverse events of EUS-CYA. Results: The majority of patients in both groups had advanced HCC, portal vein thrombosis, and Child-Pugh B cirrhosis. EUS-CYA was successful in all 27 patients with no radiographic evidence of cyanoacrylate-lipiodol embolization. Significantly lower 30- and 90-day death-adjusted cumulative incidence of rebleeding (14.8% vs 42.4%, P = 0.023 and 18.5% vs 60.6%, P = 0.002, respectively) and significantly higher variceal bleeding-free survival at 3 and 6 months (51.9% vs 21.2%, P = 0.009, 40.7% vs 15.2%, P = 0.010, respectively) were observed in the EUS-CYA group when compared with standard of care group. Conclusions: Secondary prophylaxis by EUS-CYA reduced rebleeding rate and improved variceal bleeding-free survival in patients with inoperable HCC and variceal bleeding when compared with no SP. Randomized studies are needed to confirm the benefits of EUS-CYA for this difficult-to-treat population.
MeSH term(s)	Aged ; Carcinoma, Hepatocellular/complications ; Carcinoma, Hepatocellular/mortality ; Cyanoacrylates/administration & dosage ; Endosonography/methods ; Esophageal and Gastric Varices/etiology ; Female ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/mortality ; Gastrointestinal Hemorrhage/prevention & control ; Humans ; Injections, Intralesional/methods ; Liver Neoplasms/complications ; Male ; Middle Aged ; Recurrence ; Secondary Prevention ; Survival Rate
Chemical Substances	Cyanoacrylates
Language	English
Publishing date	2020-07-09
Publishing country	Australia
Document type	Journal Article
ZDB-ID	632882-9
ISSN	1440-1746 ; 0815-9319
ISSN (online)	1440-1746
ISSN	0815-9319
DOI	10.1111/jgh.15168
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 2180: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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