Cap-assisted endoscopic full-thickness resection for small gastrointestinal stromal tumors (original) (raw)
2022, Gastrointestinal Endoscopy
With great interest, we read the study comparing preoperative, intraoperative, and follow-up functional luminal imaging probe measurements in patients undergoing myotomy for achalasia cardia. 1 In that study, the esophagogastric junction distensibility index (EGJ-DI) was measured at 4 time points (preoperative, induction, postmyotomy, and follow-up) in patients undergoing peroral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM). The authors concluded that the preoperative and induction mean EGJ-DIs were similar, with a significant increase in DI after POEM. At the 12month follow-up visit, there was a decrease in DI as compared with the postmyotomy value, although it was higher than preoperative values. These values at 4 different time points were compared by use of a paired t test. However, the paired t test should be used to compare continuous variables at 2 different time points. 2 For comparison of more than 2 mean scores at different time points, repeated-measures analysis of variance (ANOVA) should be performed. 3 The application of a paired t test to such data multiple times increases type 1 errors in multiples of 5% for each comparison. A Greenhouse-Geisser correction should be used if sphericity assumption is violated. Pairwise comparisons should be analyzed with a Bonferroni post hoc test, to find out which 2 specific means are statistically different. If overall ANOVA is not statistically significant, then a pairwise comparison should not be performed. The authors should use repeated-measures ANOVA for analysis of mean EGJ-DI at 4 different time points.
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2015
Background: The usage of statistical methods specially ANOVA and post hoc test are increase in medical research, however inaccurate application of ANOVA and post hoc test were observed commonly. So we reviewed application of ANOVA and post-hoc test in recent published biomedical research literature. Method: Original articles published in bio-medical journals subscribed by the central library of our institute (SMIMER, Surat) were reviewed for statistical applications mainly ANOVA and post hoc test. Result: Among the 1128 reviewed articles 800 (70.92%) used inferential statistical techniques. Among these 203 (25.37) articles were used ANOVA and out of that 92 (45.23%) were used post hoc test. Maximum usage of post hoc test was found in basic and paramedical research article, whereas least usage was found in the surgical articles. It has been also observed that out of the 92 original articles which applied post hoc test, in 28 (30.43%) the application was inappropriate. Conclusion: Con...
Surgical Endoscopy, 2013
Background Per oral endoscopic myotomy (POEM) is a novel treatment for esophageal motility disorders such as achalasia. To date, the extent of the myotomy has been determined based on the subjective assessment of the endoscopist. We hypothesized that the real-time measurement of esophagogastric junction (EGJ) distensibility using a novel functional lumen-imaging probe would enable objective evaluation of POEM. Methods Patients diagnosed with achalasia disorders electively underwent POEM. Using impedance planimetry with a transorally inserted functional lumen-imaging probe (EndoFLIP Ò), cross-sectional areas (CSA) and distensibilities at the EGJ were measured intraoperatively immediately before and after the transoral myotomy (n = 4). All patients completed their 6-month follow-up and two patients had repeat distensibility tests at this time. Four healthy volunteers served as a control group. Results POEM was successfully performed in all patients (4/4). Premyotomy measurements (40-ml fill mode) showed a median diameter of 6.5 mm (range = 5.2-7.9 mm) at the narrowest location of the EGJ and was 10.1 mm (7.3-13.2 mm) following POEM. CSA increased from 41.5 mm 2 (20-49 mm 2) to 86 mm 2 (41-137 mm 2) at a similar median intraballoon pressure (40.3 vs. 38.6 mmHg). The increased EGJ distensibility (DI, 1.0 vs. 2.4 mm 2 / mmHg) was comparable to that of healthy volunteers (2.7 mm 2 /mmHg). Conclusion Functional lumen distensibility measures show that POEM can result in an immediate correction of the nonrelaxing lower esophageal sphincter, which appears similar to that of healthy controls. Intraoperative EGJ profiling may be an important tool to objectively guide the needed extent and completeness of the myotomy during POEM.
Surgical Endoscopy, 2015
Background Peroral endoscopic myotomy (POEM) has been introduced as an endoscopic alternative to surgical myotomy. The endoluminal functional lumen imaging probe (endoFLIP) evaluates esophagogastric junction (EGJ) distensibility based on cross-sectional area and pressure in response to volume distension. The aim of this study was to evaluate whether there is a correlation between endoFLIP measurements during POEM and postoperative clinical outcomes in terms of symptom relief and development of post-procedure reflux. Methods We conducted a retrospective review of achalasia patients who underwent POEM and intraoperative endoFLIP at three tertiary centers. Patients were divided into two groups based on clinical response measured by Eckardt score (ES): good response (ES \ 3) or poor response (ES C 3). Post-procedure reflux was defined as the presence of esophagitis and/or abnormal pH study. EGJ diameter, cross-sectional area, and distensibility measured by endoFLIP were compared. Results Of the 63 treated patients, 50 had good and 13 had poor clinical response. The intraoperative final EGJ cross-sectional area was significantly higher in the goodresponse group versus poor-response group; median (interquartile range): 89.0 (78.5-106.7) versus 72.4 (48.8-80.0) mm 2 [p = 0.01]. The final EGJ cross-sectional area was also significantly higher in patients who had reflux esophagitis after POEM: 99.5 (91.2-103.7) versus 79.3 (57.1-94.2) mm 2 [p = 0.02]. Conclusion Intraoperative EGJ cross-sectional area during POEM for achalasia correlated with clinical response and post-procedure reflux. Impedance planimetry is a potentially important tool to guide the extent and adequacy of myotomy during POEM. Keywords Endoluminal functional lumen imaging probe Á Esophagogastric junction Á Peroral endoscopic myotomy Á Achalasia Abbreviations CSA Cross-sectional areas ES Eckardt score endoFLIP Endoluminal functional lumen imaging probe EGJ Esophagogastric junction IQR Interquartile range IRP Integrated relaxation pressure LES Lower esophageal sphincter Electronic supplementary material The online version of this article (
Pairwise multiple comparison procedures: A review
Psychological Bulletin, 1984
The literature on pairwise multiple comparisons (PMC) is reviewed. For fixed effects-between-subject experimental designs-the PMC procedures proposed by Tukey and Peritz are found to have the most desirable properties of currently available tests, given equal sample n, homogeneous population variances, and normality. When one or more of the latter conditions are violated, PMC tests suggested by Tukey and Kramer and Games and Howell are most applicable. For repeated measures designs under assumption violations, tests suggested by Myers and Keselman, Rogan, and Games may be most applicable.
Evaluation of timed barium esophagram after per-oral endoscopic myotomy to predict clinical response
Endoscopy International Open
Background and study aims The aim of this study was to evaluate whether timed barium esophagram within 24 hours post-per-oral endoscopic myotomy (POEM) (TBE-PP) could predict clinical outcomes. Patients and methods This was a single-center retrospective study of prospectively collected data on consecutive patients with ≥ 6-month follow-up who underwent POEM followed by TBE-PP. Esophageal contrast retention 2 minutes after TBE-PP was assessed as Grade 1 ( 90 %). Eckardt score, esophagogastroduodenoscopy (EGD), high-resolution manometry (HRM) and function lumen imaging probe (FLIP) of the esophagogastric junction (EGJ) were obtained at baseline. These tests along with pH testing of antisecretory therapy were repeated 6 and 24 months after POEM. Clinical response by Eckardt score ≤ 3, EGJ-distensibility index (EGJ-DI) > 2.8 mm2/mm Hg, and integrated relaxation pressure (IRP)
Statistical Tests in Medical Research
Acta Oncologica, 1992
Various propositions have been made to improve the statistical quality of medical journals: using statistical referees, promoting better collaboration between statisticians and researchers, and teaching of basic statistics to clinicians. The most frequent errors found in medical articles are misinterpretation of p-values or non-significant results and confusion between statistical and clinical significance, inappropriate use of tests requiring precise assumptions, inappropriate or not controlled multiple testing and particularly testing of post hoc hypotheses, and overemphasis on pvalues. Many errors arising from the misinterpretation of results of statistical hypothesis tests, the basic principles of this methodology are emphasized, and the usual fallacies found in the medical literature are reviewed.
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