Endoscopic treatment of scarred polyps with a non-thermal device(Endorotor):A review of the literature

Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic devices.ER procedures have evolved over the past few years from endoscopic mucosal resection(EMR)to more advanced techniques,such as endoscopic submucosal dissection and endo-scopic full-thickness resection.Complete resection and disease eradication are the ultimate goals of ER-based techniques,and novel devices have been developed to achieve these goals.The EndoRotor®Endoscopic Powered Resection System(Interscope Medical,Inc.,Northbridge,Massachusetts,United States)is one such device.The EndoRotor is a powered resection tool for the removal of alimentary tract mucosa,including post-EMR persistent lesions with scarring,and has both CE Mark and FDA clearance.This review covers available published evidence documenting the usefulness of EndoRotor for the management of recurrent colorectal polyps.

Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics

Acute variceal bleeding in patients with liver cirrhosis and portal hypertension(PHT) is the most serious emergency complication among those patients and could have catastrophic outcomes if not timely managed. Early screening by esophago-gastro-duodenoscopy(EGD) for the presence of esophageal varices(EVs) is currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in studies to investigate and validate non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder(GB) wall thickness(GBWT) measurement has been found promising in many published research articles. We aim to highlight the validity of sonographic GBWT measurement in the prediction of EVs based on the available evidence. We searched databases including Cochrane library, Pub Med, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cutoffs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy.Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced(grade Ⅲ-Ⅳ) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.

Non-pulmonary involvement in COVID-19:A systemic disease rather than a pure respiratory infection

During the early phase of the coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),diagnosis was difficult due to the diversity in symptoms and imaging findings and the variability of disease presentation.Pulmonary manifestations are reportedly the main clinical presentations of COVID-19 patients.Scientists are working hard on a myriad of clinical,epidemiological,and biological aspects to better understand SARS-CoV-2 infection,aiming to mitigate the ongoing disaster.Many reports have documented the involvement of various body systems and organs apart from the respiratory tract including the gastrointestinal,liver,immune system,renal,and neurological systems.Such involvement will result in diverse presentations related to effects on these systems.Other presentations such as coagulation defects and cutaneous manifestation may also occur.Patients with specific comorbidities including obesity,diabetes,and hypertension have increased morbidity and mortality risks with COVID-19.

Colorectal cancer in Arab world:A systematic review

BACKGROUND The incidence of colorectal cancer(CRC)is increasing among young individuals in the Arab world as well as in other regions of the world.AIM To explore the incidence and prevalence of CRC in the Arab world.METHODS The PubMed,Scopus,Web of Science,EBSCO and Wiley databases were searched to retrieve relevant articles irrespective of the language or the publication year.The search terms were("colon OR rectum OR sigmoid OR rectal OR colonic OR colorectal")AND("cancer OR malignancy OR malignant OR neoplasm")AND("Jordan"OR"United Arab Emirates"OR"Bahrain"OR"Tunisia"OR"Algeria"OR"Djibouti"OR"Saudi Arabia"OR"Sudan"OR"Syria"OR"Somalia"OR"Iraq"OR"Oman"OR"Palestine"OR"Qatar"OR"Comoros"OR"Kuwait"OR"Lebanon"OR"Libya"OR"Egypt"OR"Morocco"OR"Mauritania"OR"Yemen").Reviews,metaanalyses,and articles containing nonoriginal data were excluded.Retrieved articles were screened,and relevant data were extracted.Descriptive statistics were used for data analysis.RESULTS Nine studies were included.Five of the studies provided information regarding the prevalence of CRC.The prevalence of CRC was 0.72% in Saudi Arabia and 0.78% in the United Arab Emirate,while in Egypt,it ranged from 0.4% to 14%.Four studies showed information regarding the incidence.The annual incidence rate of CRC in Qatar was 7.5/100000/year.In Egypt,the crude incidence rate(CIR)in males was 3.1 for colon cancer and 1 for rectal cancer,while in females,it was 2.3 for colon cancer and 0.8 for rectal cancer.The age-standardized rate for CRC incidence in 2003 was 36.90 for males,26.50 for females,and 30.49 for both sexes in Saudi Arabia.In 2016,the CIRs in Saudi Arabia were 3.6 and 2.1 in females for colon cancer and rectal cancer,respectively,while in males,it was 3.3 and 2.8 for colon cancer and rectal cancer,respectively.One study in Egypt revealed that 25% of CRC cases occurred among individuals younger than 40 years old.CONCLUSION There is a considerable prevalence of CRC in some Arab countries.More studies are needed to explore the incidence and prevalence of CRC in the rest of the Arab world.

Endoscopic resection of superficial bowel neoplasia:The unmet needs in the Egyptian practice

BACKGROUND Management of superficial bowel neoplasia(SBN)in early stages is associated with better outcomes.The last few decades experienced a paradigm shift in the management of SBN with the introduction of advanced endoscopic resection techniques(ERTs).However,there are no clear data about the aspects of ERTs in Egypt despite the growing gastroenterology practice.AIM To investigate the knowledge,attitude,and practice of ERTs toward management of SBN among Egyptian practitioners and the suitability of the endoscopy units’infrastructures toward these techniques.METHODS An online 2-pages questionnaire was used.The first page comprised demographic data,and questions for all physicians,about the knowledge(11 questions)of and attitude(5 questions)toward ERTs as a therapeutic option for SBN.The second page investigated the practice of ERTs by endoscopists(6 questions)and the infrastructures of their endoscopy units(14 questions).The survey was disseminated through July 2021 and the data were collected in an excel sheet and later analyzed anonymously.RESULTS The complete responses were 833/2300(36.2%).The majority of the participants were males(n=560,67.2%),middle-aged(n=366,43.9%),consultants(n=464,55.7%),gastroenterologists(n=678,81.4%),spending≥15 years in practice(n=368,44.2%),and were working in university hospitals(n=569,68.3%).The majority correctly identified the definition of SBN(88.4%)and the terms polypectomy,endoscopic mucosal resection(EMR),and endoscopic submucosal dissection(ESD)(92.1%,90.2%,and 89.1%respectively).However,26.9%,43.2%and 49.5%did not recognize the clear indication of polypectomy,EMR,and ESD respectively.Although 68.1%of physicians are convinced about the ERTs for management of SBN;only 8.9%referred all candidate cases for ERTs.About 76.5%of endoscopists had formal training in the basic polypectomy techniques while formal training for EMR and ESD was encountered only in 31.9%and 7.2%respectively.About 71.6%and 88.4%of endoscopists did not perform EMR or ESD in the last one year.Consequently,the complication rate reported by endoscopists was limited to 18.1%(n=103)of endoscopists.Only 25.8%of endoscopists feel confident in the management of ERTs-related complications and a half(49.9%)were not sure about their competency.Regarding the end-oscopy units’infrastructures,only 4.2%of the centers had their endoscopes 100%armed with optical enhancements and 54.4%considered their institutions ready for managing ERTs-related complications.Only 18.3%(n=104)of endoscopists treated their complicated cases surgically because the most frequent ERTs-related complications were procedural bleeding(26.7%),and perforations(17%).CONCLUSION A significant deficiency was reported in the knowledge and attitude of Egyptian practitioners caring for patients with SBN toward ERTs.The lack of trained endoscopists in both EMR and ESD in part is due to unsuitable infrastructures of many endoscopy units.

Hemostatic system and COVID-19 crosstalk:A review of the available evidence

Since the discovery of severe acute respiratory syndrome coronavirus 2(SARSCoV-2)and its resultant coronavirus disease 2019(COVID-19)pandemic,respiratory manifestations have been the mainstay of clinical diagnosis,laboratory evaluations,and radiological investigations.As time passed,other pathological aspects of SARS-CoV-2 have been revealed.Various hemostatic abnormalities have been reported since the rise of the pandemic,which was sometimes superficial,transient,or fatal.Mild thrombocytopenia,thrombocytosis,venous,arterial thromboembolism,and disseminated intravascular coagulation are among the many hemostatic events associated with COVID-19.Venous thromboembolism necessitating therapeutic doses of anticoagulants is more frequently seen in severe cases of COVID-19,especially in patients admitted to intensive care units.Hemorrhagic complications rarely arise in COVID-19 patients either due to a hemostatic imbalance resulting from severe disease or as a complication of over anticoagulation.Although the pathogenesis of coagulation disturbance in SARS-CoV-2 infection is not yet understood,professional societies recommend prophylactic antithrombotic therapy in severe cases,especially in the presence of abnormal coagulation indices.The review article discusses the various available evidence on coagulation disorders,management strategies,outcomes,and prognosis associated with COVID-19 coagulopathy,which raises awareness about the importance of anticoagulation therapy for COVID-19 patients to guard against possible thromboembolic events.