Nneoma Ubah

Background/Aims: Biliary cannulation is a critical component of endoscopic retrograde cholangiopancreatography (ERCP). When standard methods fail, needle-knife precut sphincterotomy (NKPS) is commonly employed. This systematic review and meta-analysis evaluated the safety and efficacy of using NKPS as a primary technique.Methods: Electronic databases were searched for studies published between January 2000 and November 2024 that assessed outcomes of primary precut techniques. “Primary precut” was defined as needle-knife sphincterotomy performed as the initial approach without any prior standard cannulation attempts. Pooled proportions were calculated using random-effects models, and heterogeneity was assessed using the Q-test and the I² statistic.Results: The mean patient age was 57.95 years (standard deviation [SD], 7.59), and 53.23% were female. The cannulation success rate was 96.50% (95% confidence interval [CI], 94.90–97.60) with no heterogeneity (Q, 7.10; df, 8; I²=0%; p=0.935). The rates of adverse events were as follows: post-ERCP pancreatitis, 1.90% (95% CI, 1.20–3.10; I²=0; p =0.942); bleeding, 2.60% (95% CI, 1.70–4.00, I²=0; p=0.725); cholangitis, 1.50% (95% CI, 0.60–3.60; I²=45.27; p=0.067); and perforation, 0.90% (95% CI, 0.40–1.90; I²=0; p=0.948). The overall adverse event rate was 9.70% (95% CI, 5.70–16.10; I²=83.39; p<0.001).Conclusions: Primary precut sphincterotomy appears to be an effective and safe technique for biliary cannulation in ERCP. These findings support its consideration as a viable first-line approach in appropriate clinical settings.

Purpose: To evaluate how CRC screening practices differ between e-cigarette users and non-users. Design: Cross-sectional study design. Setting: National Cancer Institute’s Health Information National Trends Survey (HINTS 5). Subjects: Respondents aged 45 to 75 years. Measures: Demographics, CRC screening, e-cigarette use, cancer history, presence of comorbidities, and access to a primary care provider. Analysis: The demographic characteristics of the study participants were evaluated by their e-cigarette smoking status using chi-squared tests. The differences in CRC screening between e-cigarette users and non-users were evaluated using a multivariate logistic regression model. Results: We identified a total of 6963 participants, of which 181 (2.6%) were e-cigarette users. The prevalence of e-cigarette use was inversely related to age. A significant portion were uninsured (10.7% vs 5.9% of non-users), and almost half (49.9%) were current tobacco smokers. E-cigarette users were as likely to undergo CRC screening compared to non-users [OR 1.40; 95% CI (0.74, 2.66)]. Increasing age, educational level, health insurance, comorbidity, access to a primary care provider, personal history of cancer, and presence of a comorbidity were associated with increased participation in CRC screening. However, e-cigarette use was not associated with increased screening. Conclusion: Our study found no significant difference in CRC screening rates between e-cigarette users and non-users. While screening behaviors appear unaffected for now, ongoing surveillance is important as more users reach screening age given the uncertainties surrounding the long-term effects of e-cigarette use.

INTRODUCTION: Colorectal cancer (CRC) is a major cause of cancer deaths. We evaluated the effect of health insurance type and primary care provider (PCP) access on CRC screening. METHODS: HINTS data were used to analyze CRC screening. RESULTS: Individuals aged 50 to 65 years had comparable screening rates across all insurance types. Beyond 65 years, individuals with Medicare or Medicare with private insurance were more likely to undergo screening than private insurance users. PCP access increased CRC screening rates. Among PCP users, Medicare, income, and smoking status influenced screening. DISCUSSION: Medicare and PCP access influence CRC screening. All individuals should be linked with PCPs.