Endoscopic ultrasound fine needle aspiration vs fine needle biopsy in solid lesions: A multi-center analysis.

BACKGROUND: While endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) is considered a preferred technique for tissue sampling for solid lesions, fine needle biopsy (FNB) has recently been developed. AIM: To compare the accuracy of FNB vs FNA in determining the diagnosis of solid lesions. METHODS: A retrospective, multi-center study of EUS-guided tissue sampling using FNA vs FNB needles. Measured outcomes included diagnostic test characteristics (i.e., sensitivity, specificity, accuracy), use of rapid on-site evaluation (ROSE), and adverse events. Subgroup analyses were performed by type of lesion and diagnostic yield with or without ROSE. A multivariable logistic regression was also performed. RESULTS: A total of 1168 patients with solid lesions (n = 468 FNA; n = 700 FNB) underwent EUS-guided sampling. Mean age was 65.02 ± 12.13 years. Overall, sensitivity, specificity and accuracy were superior for FNB vs FNA (84.70% vs 74.53%; 99.29% vs 96.62%; and 87.62% vs 81.55%, respectively; P < 0.001). On subgroup analyses, sensitivity, specificity, and accuracy of FNB alone were similar to FNA + ROSE [(81.66% vs 86.45%; P = 0.142), (100% vs 100%; P = 1.00) and (88.40% vs 85.43%; P = 0.320]. There were no difference in diagnostic yield of FNB alone vs FNB + ROSE (P > 0.05). Multivariate analysis showed no significant predictor for better accuracy. On subgroup analyses, FNB was superior to FNA for non-pancreatic lesions; however, there was no difference between the techniques among pancreatic lesions. One adverse event was reported in each group. CONCLUSION: FNB is superior to FNA with equivalent diagnostic test characteristics compared to FNA + ROSE in the diagnosis of non-pancreatic solid lesions. Our results suggest that EUS-FNB may eliminate the need of ROSE and should be employed as a first-line method in the diagnosis of solid lesions.

Efficacy and Safety of Endoscopic Sleeve Gastroplasty at Mid Term in the Management of Overweight and Obese Patients: a Systematic Review and Meta-Analysis.

BACKGROUND: Endoscopic sleeve gastroplasty (ESG) has emerged as a promising technique in endoscopic bariatric and metabolic therapies (EBMTs). We aimed to perform a systematic review and meta-analysis to provide an update on its efficacy and safety. METHODS: This is a systematic review and meta-analysis was performed following the PRISMA guidelines. MEDLINE, Cochrane, EMBASE, and LILACS were searched to identify the studies related to ESG. RESULTS: Eleven studies with a total of 2170 patients were included. The average BMI pre-ESG was 35.78 kg/m2. Pooled mean %TWL observed at 6, 12, and 18 months was 15.3%, 16.1%, and 16.8% respectively. Pooled mean %EWL at 6, 12, and 18 months was 55.8%, 60%, and 73% respectively. No procedure-related mortality was reported. CONCLUSION: ESG is a safe and effective procedure for primary obesity therapy with promising short- and mid-term results.

The Effectiveness of Endoscopic Gastroplasty for Obesity Treatment According to FDA Thresholds: Systematic Review and Meta-Analysis Based on Randomized Controlled Trials.

Endoscopic bariatric therapies (EBTs) are promising alternatives to conventional surgery for obesity. The aim of this study is to compare efficacy and safety through a systematic review and meta-analysis of the endoscopic gastroplasty techniques versus conservative treatment. We searched MEDLINE, EMBASE, Cochrane CENTRAL, Lilacs/Bireme. Randomized controlled trials (RCTs) enrolling obese patients comparing endoscopic gastroplasty to sham or diet/exercise were considered eligible. Among 6014 records, three RCTs were selected for meta-analysis. The total sample was 459 patients (312 EBTs vs 147 control). Mean total body weight loss in the intervention group (IG) was 4.8% higher than the control group (CG) at 12 months (p = 0.01). The IG responder rate was 44.31% at 12 months. Therefore, the endoscopic gastroplasty is more effective than conservative therapies but do not achieve FDA thresholds.

Dissecação e Capacitação de Habilidades eCompetências Gerais na Formação Médica / Dissection and Training of Skills and General Competences in Medical Education

Relacionar o ensino e a aprendizagem da disciplinade Dissecação na Anatomia Topográfica com a capacitaçãodas habilidades gerais instituídas pelas Diretrizes CurricularesNacionais dos Cursos de Medicina: atenção à saúde, tomadade decisões, comunicação, liderança, administração egerenciamento, e educação permanente. Materiais eMétodos: Trata-se de um estudo seccional que envolveuuma população de 270 alunos do curso de Medicina daFaculdade de Medicina Nova Esperança e da UniversidadeFederal da Paraíba, ambas em João Pessoa - PB. A amostrafoi selecionada aleatoriamente e incluiu 132 graduandos, queresponderam a um questionário estruturado desenvolvidopelos autores. Resultados: Não houve diferença significativaquanto ao sexo dos alunos entrevistados, tendo sido a médiade idade de 21,7 anos. Dos 132 graduandos, houve o relatode que, frequente ou muito frequentemente, ocorreu odesenvolvimento de: capacidade de tomar decisões – 57,2%,liderança – 57,7%; administração e gerenciamento – 74,3%,comunicação – 87,1%, educação continuada – 76,0%,atenção à saúde – 59,8%. Conclusão: A dissecação temimportância na capacitação das habilidades gerais no ensinode Anatomia Topográfica e, portanto, pode contribuir com aformação do perfil do profissional médico preconizado pelasDiretrizes Curriculares Nacionais dos Cursos de Medicina...

To associate teaching and learning in the subjectDissection within the field of topographical anatomy withthe training of general skills established by the NationalCurriculum Guidelines for Medical Courses: health care,decision making, communication, leadership, administrationand management, and continuing education. Material andMethods: This was a cross-sectional study involving apopulation of 270 students of Medicine, Nova EsperançaFaculty of Medicine and the Federal University of Paraíba,both in the city of Joao Pessoa - PB. The sample wascomposed of 132 undergraduates randomly selected, whoanswered a structured questionnaire developed by theauthors. Results: There was no significant difference in thegender of the students interviewed, which had mean age of21.7 years. Of the 132 undergraduate students, often orvery often, there was the development of: decision-makingabilities – 57.2%, leadership qualities - 57.7%; administrationand management - 74.3%, communication – 87.1%, continuingeducation - 76.0%, health care attention - 59.8%. Conclusion:Anatomic dissection is important in the training of generalskills in the teaching of Topographical Anatomy and hencecan contribute to the formation of the medical profilerecommended by the National Curriculum Guidelines forMedical Courses...