PMID- 33159296
OWN - NLM
STAT- MEDLINE
DCOM- 20220105
LR  - 20220105
IS  - 1432-2218 (Electronic)
IS  - 0930-2794 (Linking)
VI  - 35
IP  - 12
DP  - 2021 Dec
TI  - Surgical management of hiatal hernia vs medical therapy to treat bleeding Cameron 
      lesions: a systematic review and meta-analysis.
PG  - 7154-7162
LID - 10.1007/s00464-020-08135-w [doi]
AB  - INTRODUCTION: Cameron lesions (CL) are an under-recognized cause of 
      gastrointestinal bleeding. Diagnosis is often impaired by technical difficulty, 
      and once diagnosed, management remains unclear. Typically, patients are medically 
      managed with proton pump inhibitors (PPI). Small studies have demonstrated 
      improved therapeutic success with surgical management, hypothesizing that 
      reversing mechanical gastric trauma and ischemia allows CL healing. This 
      systematic review and meta-analysis aim to compare therapeutic success of 
      surgical versus medical management of Cameron lesions (CL). METHODS AND 
      PROCEDURES: A comprehensive search and systematic review selected manuscripts 
      using the following inclusion criteria: (1) Endoscopically diagnosed CL (2) 
      Treated surgically (3) Follow-up for resolution of anemia or CL (4) n >/= 5 (5) 
      Excluding non-English, animal, and studies with patients < 18 years old 
      Meta-analysis was performed to compare resolution of CLs with medical and 
      surgical therapy. RESULTS: Systematic search retrieved 1664 studies, of these, 14 
      were included (randomized controlled trial = 1; prospective = 2; 
      retrospective = 11). Patients had a mean age of 61.2 years (range 24-91) and were 
      more often female (59.3%). Follow-up was between 3 and 120 months, and 82.9% of 
      patients had hernias > 5 cm. Surgical management was associated with therapeutic 
      success (OR 5.20, 1.83-14.77, I(2) = 42%, p < 0.001) with 92% having resolution, 
      compared to 67.2% for those treated with PPI. Surgical complications occurred in 
      42/109 (38.5%) of patients (48.1% for Open Hill Repair, 15.4% for laparoscopic 
      fundoplication). 40.0% of patients underwent a laparoscopic Nissen or Collis 
      fundoplication, 21.7% underwent open modified Hill repair, and 38.3% had 
      unspecified operations. Hemoglobin improved from 8.85 g/dL pre-operatively to 
      13.60 g/dL post-operatively. In six studies, surgical patients previously failed 
      medical management. CONCLUSIONS: This is the first systematic review comparing 
      surgical and medical treatment of CL. Surgical management significantly improved 
      therapeutic success. Our study supports therapeutic benefit of surgery in these 
      patients.
CI  - (c) 2020. Springer Science+Business Media, LLC, part of Springer Nature.
FAU - Verhoeff, Kevin
AU  - Verhoeff K
AD  - Department of Surgery, University of Alberta, Edmonton, AB, Canada.
FAU - Dang, Jerry T
AU  - Dang JT
AUID- ORCID: 0000-0001-8659-0934
AD  - Division of General Surgery, Department of Surgery, University of Alberta, 
      University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, 
      Canada. dang2@ualberta.ca.
FAU - Deprato, Andy
AU  - Deprato A
AD  - University of Alberta, Edmonton, AB, Canada.
FAU - Kung, Janice Y
AU  - Kung JY
AD  - John W. Scott Health Sciences Library, University of Alberta, Edmonton, AB, 
      Canada.
FAU - Switzer, Noah J
AU  - Switzer NJ
AD  - Department of Surgery, University of Alberta, Edmonton, AB, Canada.
FAU - Birch, Daniel W
AU  - Birch DW
AD  - Centre for Advancement of Surgical Education and Simulation (CASES), Royal 
      Alexandra Hospital, Edmonton, AB, Canada.
FAU - Wong, Clarence
AU  - Wong C
AD  - Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada.
FAU - Karmali, Shahzeer
AU  - Karmali S
AD  - Centre for Advancement of Surgical Education and Simulation (CASES), Royal 
      Alexandra Hospital, Edmonton, AB, Canada.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20201106
PL  - Germany
TA  - Surg Endosc
JT  - Surgical endoscopy
JID - 8806653
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Fundoplication
MH  - Gastrointestinal Hemorrhage/etiology/surgery
MH  - *Hernia, Hiatal/complications/surgery
MH  - Humans
MH  - *Laparoscopy
MH  - Middle Aged
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Young Adult
OTO - NOTNLM
OT  - Cameron lesion
OT  - Cameron ulcer
OT  - Fundoplication
OT  - Hiatal hernia
OT  - Paraesophageal hernia
EDAT- 2020/11/08 06:00
MHDA- 2022/01/06 06:00
CRDT- 2020/11/07 05:34
PHST- 2020/07/05 00:00 [received]
PHST- 2020/10/27 00:00 [accepted]
PHST- 2020/11/08 06:00 [pubmed]
PHST- 2022/01/06 06:00 [medline]
PHST- 2020/11/07 05:34 [entrez]
AID - 10.1007/s00464-020-08135-w [pii]
AID - 10.1007/s00464-020-08135-w [doi]
PST - ppublish
SO  - Surg Endosc. 2021 Dec;35(12):7154-7162. doi: 10.1007/s00464-020-08135-w. Epub 
      2020 Nov 6.