Publications by authors named "Nauzer Forbes"

Background: The surgical management of complicated diverticulitis varies across Europe. EAES members prioritized this topic to be addressed by a clinical practice guideline through an online questionnaire.

Objective: To develop evidence-informed clinical practice recommendations for key stakeholders involved in the treatment of complicated diverticulitis; to improve operative and perioperative outcomes, patient experience and quality of life through a systematic evidence-to-decision approach by a diverse, multidisciplinary panel.

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Background: We performed a systematic review and network meta-analysis (NMA) of individualized patient data (IPD) to inform the development of evidence-informed clinical practice recommendations.

Methods: We searched MEDLINE, Embase, and Cochrane Central in October 2023 to identify RCTs comparing Hartmann's resection (HR), primary resection and anastomosis (PRA), or laparoscopic peritoneal lavage (LPL) among patients with class Ib-IV Hinchey diverticulitis. Outcomes of interest were prioritized by an international, multidisciplinary panel including two patient partners.

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Background: Colorectal cancer is the third most common malignancy globally. Early-onset colorectal cancer (EOCRC) is becoming a growing healthcare focus globally, particularly in North America. We estimated trends in incidence, mortality, and disability-adjusted life years (DALYs) for EOCRC in Canada between 1990 and 2019.

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This clinical practice guideline from the American Society for Gastrointestinal Endoscopy (ASGE) provides an evidence-based approach for strategies to diagnose and manage GERD. This document was developed using the Grading of Recommendations Assessment, Development, and Evaluation framework and serves as an update to the 2014 ASGE guideline on the role of endoscopy in the management of GERD. This updated guideline addresses the indications for endoscopy in patients with GERD as well as in the emerging population of patients who develop GERD after sleeve gastrectomy or peroral endoscopic myotomy.

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Competent endoscopic ultrasound (EUS) performance requires a combination of technical, cognitive, and non-technical skills. Direct observation assessment tools can be employed to enhance learning and ascertain clinical competence; however, there is a need to systematically evaluate validity evidence supporting their use. We aimed to evaluate the validity evidence of competency assessment tools for EUS and examine their educational utility.

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Background/objectives: Risk prediction models (RPMs) for colorectal cancer (CRC) could facilitate risk-based screening. Models incorporating biomarkers may improve the utility of current RPMs. We performed a systematic review of studies reporting RPMs for CRC that evaluated the impact of blood-based biomarkers on clinical outcome prediction at the time of screening colonoscopy in average-risk populations.

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Article Synopsis
  • The study focuses on developing guidelines for the safe use of fluoroscopy in gastrointestinal endoscopy, balancing its benefits with concerns about radiation exposure to patients and healthcare workers.
  • A modified Delphi method was used, involving three rounds of surveys with 46 experts, resulting in 43 proposed statements, of which 31 achieved consensus and were prioritized across various categories such as Patient Safety and Staff Safety.
  • The final consensus statements highlight the importance of education and safety measures, with a significant majority rated as high priority, aiming to enhance safety culture in healthcare settings while utilizing fluoroscopy.
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  • * It favors percutaneous endoscopic gastrostomy (PEG) over interventional radiology-guided options and recommends starting tube feeding within 4 hours post-procedure.
  • * Additionally, the guideline states that antiplatelet medications usually don’t need to be stopped before PEG, while anticoagulant management should involve a team discussion considering bleeding and cardiovascular risks.
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Background & Aims: Endoscopic retrograde cholangiopancreatography (ERCP)-related adverse events (AEs) are associated with morbidity, mortality, and health care expenditure. We aimed to assess incidences and comparisons of ERCP AEs.

Methods: We included studies performed after 2000 reporting on ERCP AEs from database inception through March 12, 2024.

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Bleeding complications associated with oral anticoagulant (OAC) frequently lead to emergency department visits and hospitalization. Short-term all-cause mortality after severe bleeding is substantial ranging from approximately 10% for gastrointestinal bleeding (the most frequent single site) to approximately 50% for intracranial bleeding. A protocol for multidisciplinary approach to bleeding is needed to (i) ensure rapid identification of patients at risk of adverse outcomes, (ii) optimize delivery of supportive measures, (iii) treat the source of bleeding, and (iv) administer anticoagulant reversal or hemostatic therapies judiciously for patients most likely to benefit.

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  • Stent misdeployment (SMD) is a significant challenge in EUS-guided choledochoduodenostomy (EUS-CDS) for treating malignant distal biliary obstruction, with the study aiming to define its rate and outcomes, and propose a classification system.
  • In a review of data from two randomized controlled trials involving 152 patients, SMD was found in 7.2% of cases, with most types being misdeployments of the distal flange (type I) and a small number causing minor adverse events.
  • The analysis revealed that a smaller extrahepatic bile duct diameter (≤ 15 mm) increases the likelihood of SMD or technical failures, but most misdeployments can be successfully managed
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Introduction: Clinically significant post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding (CSPEB) is common. Contemporary estimates of risk are lacking. We aimed to identify risk factors of and outcomes after CSPEB.

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Article Synopsis
  • This text serves as a correction to a previously published article identified by its DOI: 10.1055/a-2221-7792.
  • The specific details of the corrections are not provided in the request but aim to clarify or rectify errors in the original publication.
  • Such corrections are important for maintaining the accuracy and integrity of academic literature.
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  • The study aimed to create and test a report card for endoscopic retrograde cholangiopancreatography (ERCP) to improve audit and feedback, which is less researched compared to tools for procedures like colonoscopy.
  • The report card incorporated various indicators for assessing technical performance, adverse events, and patient experiences, with positive feedback from ERCP specialists on its content but concerns over the practicality of gathering detailed data for evaluation.
  • Despite challenges in data acquisition, the developed report card shows promise as a useful audit tool, especially with future advancements in video recording and AI technology aiding its implementation in clinical settings.
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  • This clinical practice guideline from the ASGE offers evidence-based recommendations for using endoscopy to diagnose and manage pancreatic masses, focusing on needle selection and sample processing.
  • It advises the use of fine-needle biopsy (FNB) needles, particularly 22-gauge over 25-gauge, and recommends fork-tip or Franseen needle types, while suggesting against routine rapid on-site evaluation (ROSE) for initial tissue acquisitions.
  • For managing biliary obstructions and pain in unresectable cases, it recommends self-expandable metal stents (SEMSs) over plastic stents, with covered SEMSs preferred when malignancy is confirmed, and celiac plexus neurolysis (CPN) for abdominal pain.
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  • Difficult biliary cannulation (DBC) significantly raises the risk of post-ERCP pancreatitis (PEP), especially when combined with high pre-procedure risk factors.
  • In a study with 1,601 participants, those undergoing DBC faced a PEP rate of 20.7% when they also had high pre-procedure risk, compared to lower rates for non-DBC groups.
  • Prophylactic measures, such as combining rectal indomethacin with pancreatic duct stenting, were found to effectively reduce the risk of PEP, even with an increasing number of PD wire passages during DBC.
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Background:  Post-endoscopic retrograde cholangiopancreatography (ERCP) adverse events (AEs) are common, as is unplanned healthcare utilization (UHU). We aimed to assess potential etiologic associations between intra-/post-procedural patient-reported experience measures (PREMs) and post-ERCP AEs and UHU. METHODS : Prospective data from a multicenter collaborative were used.

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