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Unsupervised Training Proves Effective for Esophago-Gastric Endoscopic Submucosal Dissection

Experienced endoscopists seeking competence in endoscopic submucosal dissection (ESD) faced a challenging learning curve. This study introduced an unsupervised training model. Endoscopists initially observed 30 ESD cases and performed 15 unsupervised ex-vivo ESDs. Afterward, they tackled five human distal gastric ESDs and 55 unselected esophago-gastric cases. Results were promising, with a 93.0% en-bloc resection rate, 80.7% R0 resection rate, and an average operative time of 14.0 minutes per centimeter. Unsupervised training appears to successfully guide experienced endoscopists toward ESD competence.

Journal Article by Hadjinicolaou AV, Pappas A (…) di Pietro M et 3 al. in Gastrointest Endosc

Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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Optimal Timing for Pancreatic Cancer Adjuvant Therapy: A Survival Analysis

Delving into the ideal moment for post-pancreatic adenocarcinoma surgery chemotherapy, a simulated trial tracked 1491 patients. Noteworthy findings revealed a median survival of 29.9 months for late initiators (>4-8 weeks) versus 30.4 months for early starters (0-4 weeks). Encouragingly, delaying treatment up to 8 weeks post-surgery showed comparable safety, offering a nuanced approach that respects recovery timelines and enhances adjuvant therapy accessibility.

Journal Article by Kirkegård J, Ladekarl M, Lund A and Mortensen F in Ann Surg Oncol

© 2023. The Author(s).

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Laparoscopic Showdown: Transperitoneal Triumphs in Tackling Retroperitoneal Tumors

Researchers delved into the battle of surgical approaches for benign retroperitoneal tumors (BRTs). Analyzing data from 43 patients, the laparoscopic transperitoneal approach emerged as the superhero, boasting lower conversion rates and comparable outcomes to its retroperitoneal counterpart. With enhanced visual perspectives and bleeding control, the transperitoneal technique flexed its anatomical advantages, proving especially potent against larger tumors near crucial blood vessels. This study champions the laparoscopic transperitoneal approach as the go-to for tackling BRTs with finesse and efficacy.

Journal Article by Hou Z, Xie Q (…) Huang J et 4 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Crohn’s Surgery: Mesenteric Targeting Strategies Examined

In a daring move, researchers explored the short-term aftermath of groundbreaking mesenteric-targeted techniques in Crohn’s disease surgery. Among 186 patients undergoing innovative approaches like Kono-S anastomosis and extended mesenteric excision, results were surprisingly positive. Despite a slightly longer operation in the mesenteric excision and exclusion group, all factions exhibited comparable postoperative stays, readmission rates, and complication levels. This study signals that reshaping Crohn’s surgery with mesenteric precision is not just a theory—it’s a safe and feasible reality.

Journal Article by Holubar SD, Lipman J (…) Hull T et 10 al. in Am J Surg

Copyright © 2023. Published by Elsevier Inc.

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Cracking the Code: Gastrojejunal Anastomosis Holds Clues to Weight Regain in Gastric Bypass Graduates

Researchers delved into the post-gastric bypass world, unraveling the mystery of weight regain (WR). Examining 34 Roux-en-Y gastric bypass alumni, they discovered a correlation between the gastojejunal anastomosis (GJA) diameter and WR. However, excluding outliers with GJA over 30 mm nullified the link. The study highlights the potential of visual GJA estimation and emphasizes that more pliable GJAs (with higher distensibility index) in a subset of patients correlate with reduced WR rates, unlocking insights for clinical management pending larger confirmatory studies.

Journal Article by Razzak FA, Kerbage A (…) Dayyeh BA et 7 al. in Obes Surg

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Mind Over Matter: Anxiety and Body Image Drive Binge Eating After Bariatric Surgery

In the post-bariatric world, where the battle against severe obesity is won, anxiety and negative body image emerge as sneaky foes, fostering binge eating disorder (BED). Surveying 92 patients, the study unveils the heavyweight champions—depression, anxiety, body image concerns, poor quality of life, and obesity—linked with BED. The knockout punch comes from anxiety and body image issues, predicting BED occurrence two years post-surgery. This research sheds light on the psychological contenders impacting bariatric success.

Journal Article by Caetano N, Costa AJRB and Pinto SL in Obes Surg

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Endoscopic Ultrasound-Guided Gallbladder Drainage Proves Secure with Prolonged Stent Residency

In a quest for safety insights, researchers embarked on a year-long journey exploring Endoscopic Ultrasound-Guided Gallbladder Drainage (EUS-GBD) with lumen-apposing metal stents (LAMS). Engaging 82 high surgical-risk patients, they achieved a staggering 96.3% technical success. During the 1-year indwell, only 14.6% faced adverse events (AEs), with 6.1% experiencing recurrent biliary events. The study’s star—long-term LAMS indwell—proved safe, adding a reassuring note to the melody of endoscopic gallbladder interventions.

Journal Article by Bazaga S, García-Alonso FJ (…) Perez-Miranda M et 15 al. in J Gastroenterol Hepatol

© 2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

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Navigating Complications in Laparoscopic vs. Open D2-Gastrectomy (LOGICA Trial): Comprehensive Index Offers No Extra Perks

Researchers delved into the LOGICA trial, scrutinizing complications after gastric cancer surgery. Comparing Comprehensive Complication Index (CCI) and Clavien-Dindo Classification (CDC), they discovered no significant difference in complication burden between laparoscopic and open D2-gastrectomy. The verdict? While both indices correlated for hospitalization, ICU-stay, and reoperations, the CCI brought no extra flair, advising against its use post-gastrectomy. In the realm of gastric battles, CDC remains the reigning champ for assessing postoperative complications.

Journal Article by Triemstra L, de Jongh C (…) Ruurda JP et 6 al. in Eur J Surg Oncol

© 2023 Published by Elsevier Ltd.

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Anterior Sacrectomy Improves Pelvic Exenteration Outcomes

Researchers compare sacrectomy approaches in pelvic exenteration for advanced pelvic malignancies. Shifting from prone sacrectomy (PS) to anterior techniques (ALS, HACS), they find ALS and HACS reduce operating time, blood loss, and complications compared to PS. HACS involves more nerve and vascular resections. Despite this, adopting anterior sacrectomy enhances surgical and perioperative outcomes while maintaining oncological effectiveness. Surgeons are encouraged to embrace these safer, anterior approaches for improved pelvic exenteration outcomes.

Journal Article by van Kessel CS, Waller J (…) Solomon MJ et 4 al. in Ann Surg

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Liver Transplant Impact on Ileal Pouch Outcomes in PSC-IBD

For patients with primary sclerosing cholangitis and inflammatory bowel disease (PSC-IBD), this study explores the influence of liver transplantation (LT) on ileal pouch-anal anastomosis (IPAA) outcomes. Among 160 patients, LT correlated with higher chronic pouchitis rates but didn’t affect overall and pouch survival. Nontransplanted patients had more PSC-related deaths. IPAA timing regarding LT didn’t impact short- or long-term pouch outcomes. Results suggest LT’s link to increased pouchitis but emphasize its minimal impact on IPAA and overall survival in PSC-IBD patients.

Journal Article by Maspero M, Holubar SD (…) Hull TL et 7 al. in Ann Surg

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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