Pub Date : 2025-09-01DOI: 10.1016/j.igie.2025.06.006
Shanshan Wang MD , Huaibin M. Ko MD , Bo Shen MD
Proper bowel preparation is crucial for endoscopic evaluation and intervention of the ileal pouch; yet, evidence on optimal regimens remains unclear. Although guidelines recommend the polyethylene glycol (PEG) regimens in patients with inflammatory bowel disease, sodium phosphate-based (NaP) enemas often are used for convenience. Although oral NaP has been linked to mucosal injury, similar effects from enemas have not been documented, to our knowledge. We report a case of hemorrhagic pouchitis after an NaP enema use in a patient with Crohn’s disease of the pouch who required repeated endoscopic stricturotomy. Endoscopic hemostatic agents were applied and stricture therapy was deferred to avoid further injury. No other prohemorrhagic causes besides NaP enema were identified. One month later, repeat pouchoscopy using PEG preparation showed no signs of active or recent bleeding, and endoscopic stricturotomy was successfully delivered. NaP enema should be used with caution in patients with an ileal pouch, as they can induce mucosal injury or mimic worsening pouchitis, potentially leading to misdiagnosis and inappropriate management.
{"title":"Hemorrhagic pouchitis after bowel preparation with sodium phosphate—based enema: a case report","authors":"Shanshan Wang MD , Huaibin M. Ko MD , Bo Shen MD","doi":"10.1016/j.igie.2025.06.006","DOIUrl":"10.1016/j.igie.2025.06.006","url":null,"abstract":"<div><div>Proper bowel preparation is crucial for endoscopic evaluation and intervention of the ileal pouch; yet, evidence on optimal regimens remains unclear. Although guidelines recommend the polyethylene glycol (PEG) regimens in patients with inflammatory bowel disease, sodium phosphate-based (NaP) enemas often are used for convenience. Although oral NaP has been linked to mucosal injury, similar effects from enemas have not been documented, to our knowledge. We report a case of hemorrhagic pouchitis after an NaP enema use in a patient with Crohn’s disease of the pouch who required repeated endoscopic stricturotomy. Endoscopic hemostatic agents were applied and stricture therapy was deferred to avoid further injury. No other prohemorrhagic causes besides NaP enema were identified. One month later, repeat pouchoscopy using PEG preparation showed no signs of active or recent bleeding, and endoscopic stricturotomy was successfully delivered. NaP enema should be used with caution in patients with an ileal pouch, as they can induce mucosal injury or mimic worsening pouchitis, potentially leading to misdiagnosis and inappropriate management.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 261-263"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.igie.2025.05.002
Andrawus Beany MD, MPH , Enrik John Torres Aguila MD, MBA , Anna Agnieszka Wawer PhD , Dauda Bawa MD , Jin Tan MBBS , Rajvinder Singh MPhil
Background and Aims
Endoscopic mucosal resection (EMR) has increasingly gained acceptance as a minimally invasive intervention for the treatment of duodenal lesions. Despite the overall good results, there can be significant morbidity associated with performing EMR in the duodenum. Data comparing hot snare and cold snare approaches in the duodenum are currently scarce. Our aim was to assess the efficacy and safety of hot snare EMR (H-EMR) versus cold snare EMR (C-EMR) for the resection of nonampullary duodenal lesions.
Methods
A retrospective analysis of a prospectively collected database of duodenal lesions treated using EMR at a single tertiary medical center between 2010 and 2023 was performed. Patient demographics, lesion and procedure characteristics, outcomes, and adverse events were analyzed. The primary outcomes studied included complete resection, as assessed by the endoscopist through visual confirmation of complete polyp resection, as well as recurrence and adverse events, including perforation and bleeding. Cost savings were assessed thereafter.
Results
Seventy-one cases of nonampullary duodenal lesions resected using the EMR technique were included (46 H-EMR; 25 C-EMR). Fifty-one lesions were resected en bloc (31 H-EMR vs 20 C-EMR), whereas 20 lesions were resected in a piecemeal fashion (15 H-EMR vs 5 C-EMR). Similar demographics and lesion and procedure characteristics were observed in both cohorts. Complete resection was 100%, and no delayed perforations occurred in either cohort. Lesions resected via H-EMR had greater rates of immediate perforation (2.2% vs 0%; P = 1.0) and delayed bleeding (9.1% vs 0%; P = .28) compared with C-EMR. Interestingly, recurrence rates were greater in the H-EMR arm (15.2% vs 8%; P = .70). C-EMR technique achieved a crude cost savings from clips alone of $135 U.S. dollars per patient compared with the H-EMR technique.
Conclusions
Although both cohorts demonstrated excellent complete resection, there was a trend toward lower adverse events and recurrence rates, as well as cost savings, when C-EMR technique was used for nonampullary duodenal lesions.
背景和目的内镜下粘膜切除术（EMR）作为一种治疗十二指肠病变的微创干预手段越来越被人们所接受。尽管总体效果良好，但在十二指肠进行EMR可能会有显著的发病率。目前比较十二指肠热陷阱和冷陷阱入路的资料很少。我们的目的是评估热圈套EMR （H-EMR）与冷圈套EMR （C-EMR）在切除非壶腹性十二指肠病变中的疗效和安全性。方法回顾性分析2010年至2023年在某三级医疗中心前瞻性收集的EMR治疗十二指肠病变的数据库。分析了患者人口统计学、病变和手术特征、结局和不良事件。研究的主要结果包括完全切除，由内镜医师通过视觉确认息肉完全切除，以及复发和不良事件，包括穿孔和出血。其后评估了节省的费用。结果采用EMR技术切除非壶腹性十二指肠病变71例（H-EMR 46例，C-EMR 25例）。51个病灶被整块切除（31个H-EMR对20个C-EMR），而20个病灶被分段切除（15个H-EMR对5个C-EMR）。在两个队列中观察到相似的人口统计学、病变和手术特征。完全切除100%，两组均未发生迟发性穿孔。与C-EMR相比，H-EMR切除的病变有更高的立即穿孔率（2.2%对0%，P = 1.0）和延迟出血率（9.1%对0%，P = 0.28）。有趣的是，H-EMR组的复发率更高（15.2% vs 8%; P = 0.70）。与H-EMR技术相比，C-EMR技术仅从夹子上就节省了每位患者135美元的成本。结论：虽然两组患者均表现出良好的完全切除，但当C-EMR技术用于非壶腹性十二指肠病变时，有降低不良事件和复发率以及节省成本的趋势。
{"title":"Hot versus cold snare endoscopic mucosal resection for nonampullary duodenal lesions: consolidating the cold revolution into clinical practice","authors":"Andrawus Beany MD, MPH , Enrik John Torres Aguila MD, MBA , Anna Agnieszka Wawer PhD , Dauda Bawa MD , Jin Tan MBBS , Rajvinder Singh MPhil","doi":"10.1016/j.igie.2025.05.002","DOIUrl":"10.1016/j.igie.2025.05.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic mucosal resection (EMR) has increasingly gained acceptance as a minimally invasive intervention for the treatment of duodenal lesions. Despite the overall good results, there can be significant morbidity associated with performing EMR in the duodenum. Data comparing hot snare and cold snare approaches in the duodenum are currently scarce. Our aim was to assess the efficacy and safety of hot snare EMR (H-EMR) versus cold snare EMR (C-EMR) for the resection of nonampullary duodenal lesions.</div></div><div><h3>Methods</h3><div>A retrospective analysis of a prospectively collected database of duodenal lesions treated using EMR at a single tertiary medical center between 2010 and 2023 was performed. Patient demographics, lesion and procedure characteristics, outcomes, and adverse events were analyzed. The primary outcomes studied included complete resection, as assessed by the endoscopist through visual confirmation of complete polyp resection, as well as recurrence and adverse events, including perforation and bleeding. Cost savings were assessed thereafter.</div></div><div><h3>Results</h3><div>Seventy-one cases of nonampullary duodenal lesions resected using the EMR technique were included (46 H-EMR; 25 C-EMR). Fifty-one lesions were resected en bloc (31 H-EMR vs 20 C-EMR), whereas 20 lesions were resected in a piecemeal fashion (15 H-EMR vs 5 C-EMR). Similar demographics and lesion and procedure characteristics were observed in both cohorts. Complete resection was 100%, and no delayed perforations occurred in either cohort. Lesions resected via H-EMR had greater rates of immediate perforation (2.2% vs 0%; <em>P</em> = 1.0) and delayed bleeding (9.1% vs 0%; <em>P</em> = .28) compared with C-EMR. Interestingly, recurrence rates were greater in the H-EMR arm (15.2% vs 8%; <em>P</em> = .70). C-EMR technique achieved a crude cost savings from clips alone of $135 U.S. dollars per patient compared with the H-EMR technique.</div></div><div><h3>Conclusions</h3><div>Although both cohorts demonstrated excellent complete resection, there was a trend toward lower adverse events and recurrence rates, as well as cost savings, when C-EMR technique was used for nonampullary duodenal lesions.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 235-241"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.igie.2025.07.002
Bo Shen MD , Phillip S. Ge MD
{"title":"Bringing therapeutic endoscopy to the world of inflammatory bowel disease","authors":"Bo Shen MD , Phillip S. Ge MD","doi":"10.1016/j.igie.2025.07.002","DOIUrl":"10.1016/j.igie.2025.07.002","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 270-289"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.igie.2025.04.002
Rabia de Latour MD , Yakira David MD , Shivangi Kothari MD , Murad Ali MD
Background and Aims
Endoscopic retrograde cholangiopancreatography (ERCP) is a vital procedure for the management of hepatobiliary disease that requires fluoroscopy and results in radiation exposure to the interventional endoscopy team. Prevention of radiation-induced injury is crucial. Prompted by the pregnancy of our advanced endoscopist, who chose to continue performing ERCP throughout the pregnancy, we conducted a radiation safety and quality improvement initiative and evaluated the impact of this on mean fluoroscopy times and radiation dose exposure to the staff present in the procedure room.
Methods
ERCPs performed between June 2018 and March 2020 were reviewed. ERCPs performed from June 2018 to June 2019 were categorized as “preinitiative” and those performed from July 2019 to March 2020 were categorized as “postinitiative.” Interventions included purchase of a new fluoroscopy bed, new lead skirt for the bed and c-arm receiver, mindful fluoroscopy use by attending physician only, appropriate wear of dosimeter badges, and quality evaluation of personal protective equipment such as lead shielding. Data were collected on mean fluoroscopy time per procedure and each provider’s monthly radiation dosage.
Results
In the preinitiative group, 198 ERCPs were performed. Mean fluoroscopy time was 12.1 minutes per case. In the postinitiation group, 110 ERCPs were performed, with a mean fluoroscopy time of 6.3 minutes per case (48% reduction, P < .01). For all providers, the average monthly shallow dose equivalent went from 102.49 to 31.35 milli–roentgen equivalent man (69.5% reduction, P < .01). The fetal dosimeter badge worn at waist level of the pregnant provider under the lead shield detected less than the lowest detectable reading every month.
Conclusions
Quality improvement initiatives coupled with adequate personal protective equipment can result in significant improvement in the radiation exposure of advanced endoscopy staff during ERCP. Performing ERCP during pregnancy is a potentially feasible option if proper techniques and policy are implemented to protect the fetus.
{"title":"Impact of an endoscopic retrograde cholangiopancreatography radiation safety initiative on pregnant and nonpregnant staff dose exposures: a quality improvement initiative","authors":"Rabia de Latour MD , Yakira David MD , Shivangi Kothari MD , Murad Ali MD","doi":"10.1016/j.igie.2025.04.002","DOIUrl":"10.1016/j.igie.2025.04.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic retrograde cholangiopancreatography (ERCP) is a vital procedure for the management of hepatobiliary disease that requires fluoroscopy and results in radiation exposure to the interventional endoscopy team. Prevention of radiation-induced injury is crucial. Prompted by the pregnancy of our advanced endoscopist, who chose to continue performing ERCP throughout the pregnancy, we conducted a radiation safety and quality improvement initiative and evaluated the impact of this on mean fluoroscopy times and radiation dose exposure to the staff present in the procedure room.</div></div><div><h3>Methods</h3><div>ERCPs performed between June 2018 and March 2020 were reviewed. ERCPs performed from June 2018 to June 2019 were categorized as “preinitiative” and those performed from July 2019 to March 2020 were categorized as “postinitiative.” Interventions included purchase of a new fluoroscopy bed, new lead skirt for the bed and c-arm receiver, mindful fluoroscopy use by attending physician only, appropriate wear of dosimeter badges, and quality evaluation of personal protective equipment such as lead shielding. Data were collected on mean fluoroscopy time per procedure and each provider’s monthly radiation dosage.</div></div><div><h3>Results</h3><div>In the preinitiative group, 198 ERCPs were performed. Mean fluoroscopy time was 12.1 minutes per case. In the postinitiation group, 110 ERCPs were performed, with a mean fluoroscopy time of 6.3 minutes per case (48% reduction, <em>P</em> < .01). For all providers, the average monthly shallow dose equivalent went from 102.49 to 31.35 milli–roentgen equivalent man (69.5% reduction, <em>P</em> < .01). The fetal dosimeter badge worn at waist level of the pregnant provider under the lead shield detected less than the lowest detectable reading every month.</div></div><div><h3>Conclusions</h3><div>Quality improvement initiatives coupled with adequate personal protective equipment can result in significant improvement in the radiation exposure of advanced endoscopy staff during ERCP. Performing ERCP during pregnancy is a potentially feasible option if proper techniques and policy are implemented to protect the fetus.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 225-234"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.igie.2025.05.004
Julia Ding MD , Nabil Shalabi PhD , Colin Tracey BS , Julian Maldonado MD , Manish Gala MD , Niora Fabian DVM , Andrew Pettinari BVMS , Giovanni Traverso MB, BChir, PhD
Background and Aims
Inadequate insufflation is a common problem during colonoscopies, with gas leakage from the anus hindering luminal visualization. This study examines the prevalence of this problem through a survey of gastroenterologists, which motivated the development of our insufflation leakage management rectal seal device, RECSEAL.
Methods
The RECSEAL was developed based on the need identified from gastroenterologists regarding the rate and management methods of inadequate insufflation. The RECSEAL, measuring 55 mm in diameter and 50 mm in length, was designed and silicone injection-molded to safely insert and reside in the anal canal without migrating or hindering movement of the colonoscope. To evaluate the RECSEAL, a colonoscope was outfitted with a pressure sensor to measure colonic pressure while visualizing the lumen in a bench, ex vivo, and in vivo in pig models. In the ex vivo study, a small injury was introduced to the anal sphincter to simulate poor anal tone.
Results
The survey reported a rate of inadequate insufflation of 6.6% that required intervention using gluteal pressure maneuvers. In bench testing and the ex vivo model, the RECSEAL maintained lumen pressures in which both an intact and an injured anal sphincter showed significantly higher (P < .0001) mean pressures with the RECSEAL (32-33 mm Hg) than the control (0.3-3.6 mm Hg). The seal improved lumen visualization in the collapsed colon with inadequate insufflation. The RECSEAL was shown to be feasible in an in vivo model.
Conclusions
The flexible RECSEAL allowed higher luminal pressures in the colon and may improve colon insufflation and visualization.
背景和目的在结肠镜检查过程中，由于肛门气体泄漏阻碍了腔镜的显示，导致充气不足是一个常见的问题。本研究通过对胃肠病学家的调查来研究这一问题的普遍性，这促使了我们的充气泄漏管理直肠密封装置RECSEAL的发展。方法RECSEAL是根据胃肠病学家对充气不足率和管理方法的需求而制定的。RECSEAL直径55毫米，长50毫米，经硅胶注射成型，可安全地插入肛管，不会迁移或妨碍结肠镜的运动。为了评估RECSEAL，在实验台上、离体和体内猪模型的结肠镜中配备了一个压力传感器来测量结肠压力。在离体研究中，对肛门括约肌进行小损伤以模拟肛门张力差。结果该调查报告了6.6%的充气率不足，需要采用臀压手法进行干预。在实验室测试和离体模型中，RECSEAL维持了肛门括约肌的管腔压力，其中完整和受伤的肛门括约肌的RECSEAL的平均压力（32-33 mm Hg）明显高于对照组（0.3-3.6 mm Hg） （P < 0.0001）。在充气式不足的塌陷结肠中，密封改善了管腔的可见性。RECSEAL在体内模型中是可行的。结论柔性RECSEAL可提高结肠腔压，改善结肠充气式和显像。
{"title":"Colon insufflation and visualization management using a novel rectal seal device","authors":"Julia Ding MD , Nabil Shalabi PhD , Colin Tracey BS , Julian Maldonado MD , Manish Gala MD , Niora Fabian DVM , Andrew Pettinari BVMS , Giovanni Traverso MB, BChir, PhD","doi":"10.1016/j.igie.2025.05.004","DOIUrl":"10.1016/j.igie.2025.05.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Inadequate insufflation is a common problem during colonoscopies, with gas leakage from the anus hindering luminal visualization. This study examines the prevalence of this problem through a survey of gastroenterologists, which motivated the development of our insufflation leakage management rectal seal device, RECSEAL.</div></div><div><h3>Methods</h3><div>The RECSEAL was developed based on the need identified from gastroenterologists regarding the rate and management methods of inadequate insufflation. The RECSEAL, measuring 55 mm in diameter and 50 mm in length, was designed and silicone injection-molded to safely insert and reside in the anal canal without migrating or hindering movement of the colonoscope. To evaluate the RECSEAL, a colonoscope was outfitted with a pressure sensor to measure colonic pressure while visualizing the lumen in a bench, ex vivo, and in vivo in pig models. In the ex vivo study, a small injury was introduced to the anal sphincter to simulate poor anal tone.</div></div><div><h3>Results</h3><div>The survey reported a rate of inadequate insufflation of 6.6% that required intervention using gluteal pressure maneuvers. In bench testing and the ex vivo model, the RECSEAL maintained lumen pressures in which both an intact and an injured anal sphincter showed significantly higher (<em>P</em> < .0001) mean pressures with the RECSEAL (32-33 mm Hg) than the control (0.3-3.6 mm Hg). The seal improved lumen visualization in the collapsed colon with inadequate insufflation. The RECSEAL was shown to be feasible in an in vivo model.</div></div><div><h3>Conclusions</h3><div>The flexible RECSEAL allowed higher luminal pressures in the colon and may improve colon insufflation and visualization.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 218-224"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.igie.2025.07.001
Linda S. Lee MD , Brian Fleming MBA
{"title":"X-ray vision in 2025","authors":"Linda S. Lee MD , Brian Fleming MBA","doi":"10.1016/j.igie.2025.07.001","DOIUrl":"10.1016/j.igie.2025.07.001","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 290-295"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.igie.2025.02.003
Erica Loon DO , Rahul Karna MD , Amir Sultan Seid MD , Mohammad Bilal MD , Nabeel Azeem MD
Background and Aims
Post–peroral endoscopic myotomy (POEM) gastroesophageal reflux is a common adverse event. Intraoperative fluoroscopy (IOF) can help identify the gastroesophageal junction (GEJ) during submucosal tunneling and evaluate the extent of myotomy into the stomach during POEM. In this study, we investigated the use of IOF to predict and prevent post-POEM GERD (PPG).
Methods
This was a retrospective review of all patients who underwent POEM with IOF at our institution. A blinded gastroenterologist measured the fluoroscopic angle (FA) between the endoscope tip at the GEJ, before submucosal tunneling, and at the distal extent of the submucosal tunnel into the cardia. The FA was compared in patients with and without PPG at 3 and 12 months.
Results
Sixty-seven patients were included. The median FA was wider in patients on a proton pump inhibitor at 3 months (10.30 vs –1.35 degrees, P = .28) and 12 months (6.20 vs –1.05 degrees, P = .46) and in patients with presence of heartburn symptoms at 3 months (6.20 vs 2.35 degrees, P = .49) and 12 months (15.10 vs 0.15 degrees, P = .16).
Conclusions
Our study suggests that IOF could be used to tailor the myotomy to preserve sling fibers and in turn reduce PPG. Although our findings did not show statistical significance, the trend toward increased PPG in patients with a wider FA warrants a prospective controlled study to further test this hypothesis.
背景与目的经口后内镜下肌切开术（POEM）胃食管反流是一种常见的不良事件。术中透视（IOF）可以帮助在粘膜下隧道构筑过程中识别胃食管交界处（GEJ），并评估POEM过程中肌切开术进入胃的程度。在这项研究中，我们研究了使用IOF来预测和预防诗后胃食管反流（PPG）。方法回顾性分析我院所有经POEM合并IOF的患者。一名盲法胃肠病学家测量了内镜尖端在粘膜下隧道形成前的GEJ和粘膜下隧道进入贲门的远端之间的透视角度（FA）。比较有和没有PPG的患者在3个月和12个月时的FA。结果纳入67例患者。服用质子泵抑制剂的患者在3个月（10.30 vs -1.35度，P = 0.28）和12个月（6.20 vs -1.05度，P = 0.46）时的中位FA更宽，而出现胃灼热症状的患者在3个月（6.20 vs 2.35度，P = 0.49）和12个月（15.10 vs 0.15度，P = 0.16）时的中位FA更宽。结论IOF可用于调整肌切开术，以保留悬吊纤维，从而降低PPG。虽然我们的研究结果没有统计学意义，但更宽FA患者PPG增加的趋势值得一项前瞻性对照研究来进一步验证这一假设。
{"title":"Use of intraoperative fluoroscopy to reduce post–peroral endoscopic myotomy reflux: a proof-of-concept study","authors":"Erica Loon DO , Rahul Karna MD , Amir Sultan Seid MD , Mohammad Bilal MD , Nabeel Azeem MD","doi":"10.1016/j.igie.2025.02.003","DOIUrl":"10.1016/j.igie.2025.02.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Post–peroral endoscopic myotomy (POEM) gastroesophageal reflux is a common adverse event. Intraoperative fluoroscopy (IOF) can help identify the gastroesophageal junction (GEJ) during submucosal tunneling and evaluate the extent of myotomy into the stomach during POEM. In this study, we investigated the use of IOF to predict and prevent post-POEM GERD (PPG).</div></div><div><h3>Methods</h3><div>This was a retrospective review of all patients who underwent POEM with IOF at our institution. A blinded gastroenterologist measured the fluoroscopic angle (FA) between the endoscope tip at the GEJ, before submucosal tunneling, and at the distal extent of the submucosal tunnel into the cardia. The FA was compared in patients with and without PPG at 3 and 12 months.</div></div><div><h3>Results</h3><div>Sixty-seven patients were included. The median FA was wider in patients on a proton pump inhibitor at 3 months (10.30 vs –1.35 degrees, <em>P</em> = .28) and 12 months (6.20 vs –1.05 degrees, <em>P</em> = .46) and in patients with presence of heartburn symptoms at 3 months (6.20 vs 2.35 degrees, <em>P</em> = .49) and 12 months (15.10 vs 0.15 degrees, <em>P</em> = .16).</div></div><div><h3>Conclusions</h3><div>Our study suggests that IOF could be used to tailor the myotomy to preserve sling fibers and in turn reduce PPG. Although our findings did not show statistical significance, the trend toward increased PPG in patients with a wider FA warrants a prospective controlled study to further test this hypothesis.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 3","pages":"Pages 213-217"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145099342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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