Abstract:
BACKGROUND:Optimal management of asymptomatic pancreatic cystic neoplasm is not known. OBJECTIVE:In a decision analysis, the cost-effectiveness of different strategies for managing solitary, asymptomatic pancreatic cystic neoplasm were compared. INTERVENTION:Three strategies were examined in a Markov model with a third-party-payer perspective. In strategy I, the natural history of the lesion was followed without any specific intervention. In strategy II, an aggressive surgical approach was considered in that all patients were considered for resection. In strategy III, an initial EUS-guided FNA with cyst fluid analysis was performed for risk stratification, and patients with mucinous cysts were considered for resection. Transitional probabilities, discounted cost, and utility values to estimate quality-adjusted life years were obtained from published information. An operability risk score based on patient age, comorbidity, and size and location of the cyst was developed to estimate the probability of surgical resection. RESULTS:In the baseline analysis, strategy III yielded the highest quality-adjusted life years with an acceptable incremental cost-effectiveness ratio. In a Monte Carlo analysis, the relative risk of patients developing unresectable pancreatic cancer was decreased in strategy III compared to the other strategies. Although threshold analyses identified few important parameters influencing the conclusion of the analysis, operability risk score was the critical determinant of the optimal management strategy. LIMITATIONS:Indirect costs were not considered in this analysis. CONCLUSION:For asymptomatic patients with incidental solitary pancreatic cystic neoplasm, a blanket policy of surgical resection for all patients cannot be justified. A strategy based on risk stratification of malignant potential by EUS-guided FNA and cyst fluid analysis is the most cost-effective strategy.
journal_name
Gastrointest Endoscjournal_title
Gastrointestinal endoscopyauthors
Das A,Ngamruengphong S,Nagendra S,Chak Adoi
10.1016/j.gie.2009.02.013subject
Has Abstractpub_date
2009-10-01 00:00:00pages
690-699.e6issue
4eissn
0016-5107issn
1097-6779pii
S0016-5107(09)00339-3journal_volume
70pub_type
杂志文章abstract::The role of noninvasive evaluation of the common bile duct combined with selective preoperative endoscopic retrograde cholangiography and sphincterotomy was prospectively evaluated in 1390 consecutive patients subjected to laparoscopic cholecystectomy. Preoperative common bile duct testing included liver chemistries, ...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/s0016-5107(95)70235-0
更新日期:1995-07-01 00:00:00
abstract:BACKGROUND:Diverticulotomy is a standard treatment for Zenker's diverticulum (ZD). This technique was adapted to flexible endoscopy. OBJECTIVE:We report our long-term results of ZD treatment by using flexible endoscopy assisted by a soft diverticuloscope. DESIGN:Follow-up study. SETTING:Academic hospital. Tertiary-c...
journal_title:Gastrointestinal endoscopy
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abstract:BACKGROUND:The rate of spontaneous migration of bile duct stones through the duodenal papilla is not well known. Endoscopic retrograde cholangiography (ERC) has been the standard method to diagnose bile duct stones, but accumulating data show there is a good agreement between ERC and endoscopic ultrasonography (EUS). T...
journal_title:Gastrointestinal endoscopy
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doi:10.1016/s0016-5107(00)70414-7
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND AND AIMS:The greatest known risk factor for duodenal cancer in familial adenomatous polyposis (FAP) is Spigelman stage (SS) IV duodenal polyposis. Endoscopic surveillance is recommended in FAP patients with SS 0 to IV, and prophylactic duodenectomy should be considered in SS IV. Cancer occurs in patients wit...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2018.07.033
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Endoscopic ultrasonographically guided fine-needle aspiration (EUS-FNA) is a safe and accurate method for obtaining diagnostic material from lesions within and immediately adjacent to the upper GI tract. OBJECTIVE:To determine whether EUS Trucut biopsy (EUS-TCB) (Quickcore, Wilson-Cook, Winstom Salem, NC) c...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2006.02.056
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:The aim of this study was to evaluate the efficacy and the safety of the covered Wallstent, a commercially available silicone-covered, self-expandable metallic stent (covered Wallstent), for the treatment of distal malignant biliary obstruction. METHODS:Sixty-nine consecutive patients with unresectable dist...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章,多中心研究
doi:10.1016/j.gie.2005.06.030
更新日期:2005-11-01 00:00:00
abstract::A study of selective sedation for colonoscopy was conducted in two parts. All procedures were performed by one experienced colonoscopist. In the first phase, 41 patients received intravenous sedation before colonoscopy and were then prospectively randomized to either a "not-reversed" group, which did not receive fluma...
journal_title:Gastrointestinal endoscopy
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:A trucut needle biopsy device that can be used to obtain specimens from the pancreas and other perigastric organs under EUS guidance has been developed and successfully tested in animals. Moreover, EUS-guided trucut needle biopsy has been used safely in humans and appears to provide more accurate results tha...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/s0016-5107(03)02538-0
更新日期:2004-02-01 00:00:00
abstract::Fifty-two self-expanding metal stents were implanted in 39 patients with malignant (35 patients) or benign (4 patients) biliary stenoses. The stents were inserted and properly released by means of a 7 or 9 French gauge delivery catheter via the percutaneous (20 patients) or transpapillary (19 patients) route. In all c...
journal_title:Gastrointestinal endoscopy
pub_type: 临床试验,杂志文章
doi:10.1016/s0016-5107(91)70617-2
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:The systematic use of metal stents to treat biliary obstruction is restricted by high cost compared with plastic stents. The aims of this study were to compare cost and efficacy of plastic stents and metal stents in the treatment of patients with malignant common bile duct strictures and to define factors th...
journal_title:Gastrointestinal endoscopy
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1067/mge.2003.66
更新日期:2003-02-01 00:00:00
abstract:BACKGROUND:Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) after surgical gastrectomy is a technically difficult procedure because of the limited working space in the remnant stomach as well as the presence of severe gastric fibrosis and staples under the suture line. OBJECTIVE:We evaluated clini...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2013.02.006
更新日期:2013-07-01 00:00:00
abstract::The complication rate for diagnostic laparoscopy reported in the literature is very low (1.07%, 0.3%, and 0.03% for minor and major complications, and deaths, respectively). A prospective study of the complications of diagnostic laparoscopy by 17 gastroenterologists in the Dallas-Fort Worth metropolitan area is report...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/s0016-5107(84)72394-7
更新日期:1984-08-01 00:00:00
abstract:BACKGROUND AND AIMS:Endoscopic multiband mucosectomy (EMBM) has been used to treat early Barrett's esophagus and esophagogastric junction neoplasia, yet it is seldom reported for the treatment of early esophageal squamous cell neoplasia. Here we retrospectively evaluated the feasibility, safety, and efficacy of EMBM fo...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2016.04.015
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:Fully covered stents are designed to resist tissue ingrowth that is often seen with partially covered stents. An issue with fully covered stents is the risk of migration. OBJECTIVE:We aimed to determine efficacy, recurrent dysphagia, and complications of the SX-ELLA stent Esophageal HV, which is fully cover...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章,多中心研究
doi:10.1016/j.gie.2009.09.023
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:Intravenous sedation/analgesia for colonoscopy is accompanied with certain risks and postprocedure drowsiness. We sought to determine whether inhaled nitrous oxide (Entonox: 50% nitrous oxide, 50% oxygen) provides adequate analgesia for colonoscopy and the impact of this agent on recovery. METHODS:All patie...
journal_title:Gastrointestinal endoscopy
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0016-5107(00)70354-3
更新日期:2000-03-01 00:00:00
abstract:BACKGROUND:Most cases of duodenal carcinoid have conventionally been treated by surgical resection. The aim of our study was to explore the feasibility of endoscopic resection in small duodenal carcinoids. METHODS:The study population consisted of seven patients with small duodenal carcinoids. The diagnosis was confir...
journal_title:Gastrointestinal endoscopy
pub_type: 临床试验,杂志文章
doi:10.1016/s0016-5107(98)70246-9
更新日期:1998-06-01 00:00:00
abstract:BACKGROUND:Endoscopic papillectomy of benign papillary tumor is still not widely practiced. Intraductal growth has been considered a contraindication for endoscopic therapy. This prospective study evaluates endoscopic papillectomy for treatment of benign papillary tumors without and with intraductal growth. METHODS:Mo...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2005.04.053
更新日期:2005-10-01 00:00:00
abstract:BACKGROUND:Uncovered, rather than covered, metal stents are commonly used for palliation of malignant gastric outlet obstruction because of the low risk of stent migration, but tumor ingrowth risk is a major drawback. Few reports address malignant obstruction after gastric surgery. OBJECTIVE:Our purpose was to compare...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2006.08.030
更新日期:2007-05-01 00:00:00
abstract::We compared the results of ultrasonically guided fine needle aspiration biopsy and laparoscopy in 63 patients who underwent both procedures. In this series, fine needle biopsy showed a sensitivity of 75.6% with a 84.1% overall accuracy. Laparoscopy demonstrated a 74.3% sensitivity with an overall accuracy of 82.7%. Th...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/s0016-5107(88)71318-8
更新日期:1988-05-01 00:00:00
abstract:BACKGROUND:Nonvariceal upper GI bleeding (NVUGIB) that occurs in patients already hospitalized for another condition is associated with increased mortality, but outcome predictors have not been consistently identified. OBJECTIVE:To assess clinical outcomes of NVUGIB and identify predictors of mortality from NVUGIB in ...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章,多中心研究
doi:10.1016/j.gie.2013.10.009
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:EMR for the treatment of duodenal adenomas is challenging due to a thin wall and rich vascularity. OBJECTIVE:To evaluate a novel technique of "underwater" EMR without prior submucosal injection for the removal of large (≥2 cm) laterally spreading nonampullary duodenal adenomas. DESIGN:Prospective, observat...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2013.03.1330
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:With recent advances in endoscopy, endoscopic techniques have surpassed esophagectomy in the treatment of dysplastic Barrett's esophagus (BE). OBJECTIVE:To compare the efficacy and safety of complete EMR and radiofrequency ablation (RFA) in the treatment of dysplastic BE. DESIGN:Systematic review of litera...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章,评审
doi:10.1016/j.gie.2013.11.030
更新日期:2014-05-01 00:00:00
abstract:BACKGROUND:A screening colonoscopy is recommended in first-degree relatives (FDRs) of colorectal cancer patients; few prospective, controlled studies have evaluated colorectal findings in a population-based screening program. OBJECTIVE:To evaluate the prevalence of colorectal neoplasia (adenomas and adenocarcinomas) i...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2010.12.025
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND AND AIMS:Education on preparation is essential for successful colonoscopy. This study aimed to evaluate the impact of audiovisual (AV) re-education via a smartphone on bowel preparation quality before colonoscopy. METHODS:A prospective, endoscopist-blinded, randomized, controlled study was performed. Patien...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.gie.2017.09.007
更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:Celiac disease (CD) is a gluten-dependent enteropathy. The current standard for diagnosing CD involves obtaining 4 biopsy samples from the descending duodenum. It has been suggested that duodenal bulb biopsies may also be useful. OBJECTIVE:To assess the utility of bulbar biopsies for the diagnosis of CD in ...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2010.05.021
更新日期:2010-09-01 00:00:00
abstract::The endoscopic Congo red test allows accurate and rapid evaluation of the completeness of vagotomy and may result in a lower incidence of postoperative incomplete vagotomy. This report describes 44 patients tested during proximal gastric vagotomy. Evidence of incomplete vagotomy was found in over 95% at the conclusion...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/s0016-5107(87)71680-0
更新日期:1987-12-01 00:00:00
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journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2016.11.027
更新日期:2017-03-01 00:00:00
abstract::Small bowel mucosal biopsy specimens were studied in 52 consecutive patients. Twenty-six patients underwent biopsy by a suction capsule and 16 patients by endoscopy using an 8-mm forceps. Additionally, 10 patients were asked to undergo biopsy by both techniques in the same morning. Material was obtained in 81% of atte...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/s0016-5107(86)71846-4
更新日期:1986-08-01 00:00:00
abstract:BACKGROUND:The thoracic duct plays an important role in fluid balance, lipid absorption, and transport of immunologically active cells. The thoracic duct is difficult to access but is readily identified by EUS. The present study assessed the feasibility of EUS identification and EUS-guided puncture of the thoracic duct...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/s0016-5107(03)02880-3
更新日期:2004-04-01 00:00:00
abstract:BACKGROUND:There are few data about the performance variability among endoscopists participating to nationwide or regionwide colorectal cancer screening programs. OBJECTIVE:To assess the variability of neoplasia detection rates among endoscopists participating in a regional colorectal cancer screening program based on...
journal_title:Gastrointestinal endoscopy
pub_type: 杂志文章
doi:10.1016/j.gie.2009.08.032
更新日期:2010-02-01 00:00:00