ABSTRACT
Background: "Rendez-vous" (RV) technique is a mixed-technique which uses both laparoscopic and endoscopic skills; however, the evidence is contradictory regarding the implementation of this technique or the 2-step sequential technique (endoscopic retrograde cholangiopancreatography [ERCP] followed by laparoscopic cholecystectomy [LC]) in the management of cholecysto-choledocholitiasis. Objective: To estimate the association between the implementation of RV technique and the presence of post-surgical complications as primary outcome, using as comparator the 2-step sequential technique. Method: An observational, analytical, retrospective study was conducted, using as exposed cohort the medical records from patients with a diagnosis of cholelithiasis, cholecystitis, or mild biliary pancreatitis. The exposed cohort underwent RV technique, while the unexposed cohort were those which underwent two step technique. Results: There was a lower post-surgical complication rate in the RV group (0%) compared with the 10.1% (p = 0.3617) in the control group. Also, RV technique showed a lesser hospitalization time (p = 0.0377) and a lesser post-surgical hospitalization time (p < 0.0001). Conclusions: RV technique is superior when compared with the 2-step sequential technique (ERCP followed by LC), based on a better surgical success rate, a fewer complications rate and less hospitalization time.
Antecedentes: La técnica de «Rendez-vous¼ (RV) es una técnica mixta en la que se combinan las habilidades endoscópicas y laparoscópicas. La evidencia es contradictoria respecto al uso de RV frente a la técnica secuencial en dos tiempos (colangiopancreatografía retrógrada endoscópica [CPRE] seguida de colecistectomía laparoscópica [CL]) para el manejo de la colecisto-coledocolitiasis. Objetivo: Estimar la asociación entre el uso de la técnica RV y la presencia de complicaciones posquirúrgicas como desenlace primario, en comparación con la técnica secuencial. Método: Se realizó un estudio observacional analítico retrospectivo que tomó como cohorte expuesta las historias clínicas de pacientes con diagnóstico de colelitiasis, colecistitis o pancreatitis leve de origen biliar sometidos a la técnica RV, y se compararon con registros en los que se realizó la técnica de dos tiempos. Resultados: La tasa de complicaciones posquirúrgicas en el grupo de RV fue del 0%, frente al 10.1% (p = 0.3617) en el grupo control. Además, la RV presentó menor tiempo de hospitalización global (p = 0.0377) y posquirúrgica (p < 0.0001). Conclusiones: La técnica RV es superior a la técnica secuencial de CPRE seguida de CL, por su mayor tasa de éxito, menor tasa de complicaciones y menor tiempo hospitalario.
ABSTRACT
BACKGROUND & AIMS: Despite the significant advances made in the diagnosis and treatment of Barrett's esophagus (BE), there is still a need for standardized definitions, appropriate recognition of endoscopic landmarks, and consistent use of classification systems. Current controversies in basic definitions of BE and the relative lack of anatomic knowledge are significant barriers to uniform documentation. We aimed to provide consensus-driven recommendations for uniform reporting and global application. METHODS: The World Endoscopy Organization Barrett's Esophagus Committee appointed leaders to develop an evidence-based Delphi study. A working group of 6 members identified and formulated 23 statements, and 30 internationally recognized experts from 18 countries participated in 3 rounds of voting. We defined consensus as agreement by ≥80% of experts for each statement and used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool to assess the quality of evidence and the strength of recommendations. RESULTS: After 3 rounds of voting, experts achieved consensus on 6 endoscopic landmarks (palisade vessels, gastroesophageal junction, squamocolumnar junction, lesion location, extraluminal compressions, and quadrant orientation), 13 definitions (BE, hiatus hernia, squamous islands, columnar islands, Barrett's endoscopic therapy, endoscopic resection, endoscopic ablation, systematic inspection, complete eradication of intestinal metaplasia, complete eradication of dysplasia, residual disease, recurrent disease, and failure of endoscopic therapy), and 4 classification systems (Prague, Los Angeles, Paris, and Barrett's International NBI Group). In round 1, 18 statements (78%) reached consensus, with 12 (67%) receiving strong agreement from more than half of the experts. In round 2, 4 of the remaining statements (80%) reached consensus, with 1 statement receiving strong agreement from 50% of the experts. In the third round, a consensus was reached on the remaining statement. CONCLUSIONS: We developed evidence-based, consensus-driven statements on endoscopic landmarks, definitions, and classifications of BE. These recommendations may facilitate global uniform reporting in BE.