Obesity is a global health problem, and less-invasive treatments are warranted. We developed a novel endoscopic intervention named peroral endoscopic myo-neurotomy (POEM-N) that is performed at the greater curvature of the gastric antrum as a bariatric/metabolic procedure and assessed its feasibility using porcine models.
Methods
Six live pigs were divided into 3 groups of 2: POEM-N with a high-fat diet (HFD) (POEM-N group); sham procedure with HFD (HF-control group); and sham procedure with normal diet (N-control group). All pigs were fed the diets for 2 weeks, underwent POEM-N or sham procedure, and were observed for 2 weeks after the procedure. The primary outcome was the safety and feasibility of POEM-N. Adverse events and histology of the area after POEM-N were evaluated to assess the procedure’s safety and feasibility. Secondary outcomes were changes in body weight and glycolipid levels.
Results
There was no severe worsening of vital signs during or after the POEM-N procedure. All pigs were well and food intake was good, with no delayed adverse events. Excessive storage of dietary residue, deformity of the gastric antrum, and fold concentration were observed after POEM-N, as expected. Histologic examination revealed hypertrophic regeneration of Auerbach’s plexus, which regulates gastric peristalsis, in both POEM-N pigs. After the procedure, HFD-induced weight gain in the POEM-N pigs slowed, and the increase in serum and liver cholesterol levels was suppressed.
Conclusions
We applied POEM-N as a bariatric/metabolic procedure and showed its safety and feasibility using porcine models.
{"title":"Gastric peroral endoscopic myo-neurotomy as less-invasive bariatric surgery in porcine models: an experimental study","authors":"Kenta Hamada MD, PhD , Yasushi Yamasaki MD, PhD , Akinobu Takaki MD, PhD , Takehiro Tanaka MD, PhD , Hiroyuki Okada MD, PhD","doi":"10.1016/j.igie.2024.06.002","DOIUrl":"10.1016/j.igie.2024.06.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Obesity is a global health problem, and less-invasive treatments are warranted. We developed a novel endoscopic intervention named peroral endoscopic myo-neurotomy (POEM-N) that is performed at the greater curvature of the gastric antrum as a bariatric/metabolic procedure and assessed its feasibility using porcine models.</div></div><div><h3>Methods</h3><div>Six live pigs were divided into 3 groups of 2: POEM-N with a high-fat diet (HFD) (POEM-N group); sham procedure with HFD (HF-control group); and sham procedure with normal diet (N-control group). All pigs were fed the diets for 2 weeks, underwent POEM-N or sham procedure, and were observed for 2 weeks after the procedure. The primary outcome was the safety and feasibility of POEM-N. Adverse events and histology of the area after POEM-N were evaluated to assess the procedure’s safety and feasibility. Secondary outcomes were changes in body weight and glycolipid levels.</div></div><div><h3>Results</h3><div>There was no severe worsening of vital signs during or after the POEM-N procedure. All pigs were well and food intake was good, with no delayed adverse events. Excessive storage of dietary residue, deformity of the gastric antrum, and fold concentration were observed after POEM-N, as expected. Histologic examination revealed hypertrophic regeneration of Auerbach’s plexus, which regulates gastric peristalsis, in both POEM-N pigs. After the procedure, HFD-induced weight gain in the POEM-N pigs slowed, and the increase in serum and liver cholesterol levels was suppressed.</div></div><div><h3>Conclusions</h3><div>We applied POEM-N as a bariatric/metabolic procedure and showed its safety and feasibility using porcine models.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 358-365"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.igie.2024.06.004
Annita Cavalcante Farias Leoncio MD, Carlos Kiyoshi Furuya PhD, Christiano Makoto Sakai PhD, Paulo Sakai PhD, Edson Ide MS
Background and Aims
Injection of solution into the submucosa is an essential step in endoscopic resections and aims to separate the mucosal layer from the muscular layer avoiding, above all, perforatNOVA Nions. This study compares the durability of the solution in bubble formation, endoscopists' opinions on the quality of the bubble during resections, and the electrical resistance of the solutions.
Methods
This double-blind study compared the following solutions: Blue Eye (B-bluee), Voluven (Voluv; 6% hydroxyethyl starch solution), 10% mannitol with .45% sodium chloride (Ma-Na45), and mannitol 20% with .9% sodium chloride (Ma-Na90). In Phase 1, a total of 5 mL of the solution was injected into the gastric antrum of a live pig; in Phase 2, two endoscopists performed 20 resections over 5 weeks; and during Phase 3, the study measured the electrical resistance of pure solutions and after injections into the submucosa of ex vivo gastric tissue.
Results
Ma-Na90 lasted the longest (28 minutes), while Ma-Na45 had the shortest duration (10 minutes). Ma-Na45 was satisfactory, and Voluv was unsatisfactory. Ma-Na90 produced the most foam, and Voluv required the longest dissection time. There was no perforation. Ma-Na45 had the highest average electrical resistance (89.62 Ω) in both the solution and tissue (391 Ω), while Ma-Na90 exhibited lower values (23 Ω and 55.75 Ω, respectively).
Conclusions
This experiment shows the level of complexity in choosing the best solution based on a combination of variables. Mannitol with sodium chloride stood out as a highlighted option due to its favorable overall results and easy accessibility.
{"title":"Experimental model in porcines to evaluate solutions used in endoscopic resections","authors":"Annita Cavalcante Farias Leoncio MD, Carlos Kiyoshi Furuya PhD, Christiano Makoto Sakai PhD, Paulo Sakai PhD, Edson Ide MS","doi":"10.1016/j.igie.2024.06.004","DOIUrl":"10.1016/j.igie.2024.06.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Injection of solution into the submucosa is an essential step in endoscopic resections and aims to separate the mucosal layer from the muscular layer avoiding, above all, perforatNOVA Nions. This study compares the durability of the solution in bubble formation, endoscopists' opinions on the quality of the bubble during resections, and the electrical resistance of the solutions.</div></div><div><h3>Methods</h3><div>This double-blind study compared the following solutions: Blue Eye (B-bluee), Voluven (Voluv; 6% hydroxyethyl starch solution), 10% mannitol with .45% sodium chloride (Ma-Na45), and mannitol 20% with .9% sodium chloride (Ma-Na90). In Phase 1, a total of 5 mL of the solution was injected into the gastric antrum of a live pig; in Phase 2, two endoscopists performed 20 resections over 5 weeks; and during Phase 3, the study measured the electrical resistance of pure solutions and after injections into the submucosa of ex vivo gastric tissue.</div></div><div><h3>Results</h3><div>Ma-Na90 lasted the longest (28 minutes), while Ma-Na45 had the shortest duration (10 minutes). Ma-Na45 was satisfactory, and Voluv was unsatisfactory. Ma-Na90 produced the most foam, and Voluv required the longest dissection time. There was no perforation. Ma-Na45 had the highest average electrical resistance (89.62 Ω) in both the solution and tissue (391 Ω), while Ma-Na90 exhibited lower values (23 Ω and 55.75 Ω, respectively).</div></div><div><h3>Conclusions</h3><div>This experiment shows the level of complexity in choosing the best solution based on a combination of variables. Mannitol with sodium chloride stood out as a highlighted option due to its favorable overall results and easy accessibility.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 346-351"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.igie.2024.07.005
Mike T. Wei MD , Shai Friedland MD
Background and Aims
Endoscopic submucosal dissection (ESD) is increasingly used for resection of benign nonpedunculated colorectal polyps and early cancers. However, there is concern that adoption of ESD may be limited by increased resource utilization with routine postprocedure admission. As endoscopic closure of ESD wounds has improved, in 2022, we adopted an outpatient colorectal ESD protocol.
Methods
This study was a retrospective evaluation of adult patients who underwent colorectal ESD from January 2022 to April 2023. When technically feasible, the wound was closed by clips or suturing. After the procedure, patients were observed for up to 2 hours and discharged if they had no abdominal pain and no intraoperative muscle injury was present. We evaluated for operative success (en-bloc, R0, and curative resection) as well as safety (postprocedure pain, perforation, delayed bleeding).
Results
One hundred eleven lesions were removed by ESD in 105 consecutive patients. Nineteen lesions (17%) had prior EMR. All lesions were successfully removed: The en-bloc resection rate was 93% and the R0 and curative resection rate was 90%. Ninety-nine wounds (89%) were closed, most commonly using clips (60/111; 54%). Two small intraprocedural perforations occurred, both managed with clip closure, and the patients did not require admission. Among patients with defect closure, there were no delayed bleeds requiring hospitalization and only 1 episode of self-limited bleeding. In contrast, among 12 patients with resection sites not amenable to closure, there were 1 delayed bleed requiring hospitalization, 2 minor bleeds assessed at the emergency department, and 2 self-limited bleeds.
Conclusions
In this retrospective study, we demonstrated the feasibility of outpatient colorectal ESD. Among 105 patients, only 2 required hospital admission: 1 for postprocedure pain and 1 for delayed bleeding. We found that after endoscopic closure of ESD wounds, hospital admission was generally unnecessary and significant postprocedure bleeding was rare.
{"title":"Evaluation of the safety and feasibility of outpatient colorectal endoscopic submucosal dissection","authors":"Mike T. Wei MD , Shai Friedland MD","doi":"10.1016/j.igie.2024.07.005","DOIUrl":"10.1016/j.igie.2024.07.005","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic submucosal dissection (ESD) is increasingly used for resection of benign nonpedunculated colorectal polyps and early cancers. However, there is concern that adoption of ESD may be limited by increased resource utilization with routine postprocedure admission. As endoscopic closure of ESD wounds has improved, in 2022, we adopted an outpatient colorectal ESD protocol.</div></div><div><h3>Methods</h3><div>This study was a retrospective evaluation of adult patients who underwent colorectal ESD from January 2022 to April 2023. When technically feasible, the wound was closed by clips or suturing. After the procedure, patients were observed for up to 2 hours and discharged if they had no abdominal pain and no intraoperative muscle injury was present. We evaluated for operative success (en-bloc, R0, and curative resection) as well as safety (postprocedure pain, perforation, delayed bleeding).</div></div><div><h3>Results</h3><div>One hundred eleven lesions were removed by ESD in 105 consecutive patients. Nineteen lesions (17%) had prior EMR. All lesions were successfully removed: The en-bloc resection rate was 93% and the R0 and curative resection rate was 90%. Ninety-nine wounds (89%) were closed, most commonly using clips (60/111; 54%). Two small intraprocedural perforations occurred, both managed with clip closure, and the patients did not require admission. Among patients with defect closure, there were no delayed bleeds requiring hospitalization and only 1 episode of self-limited bleeding. In contrast, among 12 patients with resection sites not amenable to closure, there were 1 delayed bleed requiring hospitalization, 2 minor bleeds assessed at the emergency department, and 2 self-limited bleeds.</div></div><div><h3>Conclusions</h3><div>In this retrospective study, we demonstrated the feasibility of outpatient colorectal ESD. Among 105 patients, only 2 required hospital admission: 1 for postprocedure pain and 1 for delayed bleeding. We found that after endoscopic closure of ESD wounds, hospital admission was generally unnecessary and significant postprocedure bleeding was rare.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 413-417"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.igie.2024.07.007
Stavros N. Stavropoulos MD, FASGE , Phillip S. Ge MD, FASGE
{"title":"Boldly going where no one has gone before: a history of peroral endoscopic myotomy in the United States","authors":"Stavros N. Stavropoulos MD, FASGE , Phillip S. Ge MD, FASGE","doi":"10.1016/j.igie.2024.07.007","DOIUrl":"10.1016/j.igie.2024.07.007","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 424-444"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.igie.2024.07.002
Stacia Sackmaster APN-BC , Sarah Enslin PA-C , Joseph Vicari MD, MBA, FASGE
{"title":"Advanced practice provider angle: American Society for Gastrointestinal Endoscopy advanced practice provider case of the month","authors":"Stacia Sackmaster APN-BC , Sarah Enslin PA-C , Joseph Vicari MD, MBA, FASGE","doi":"10.1016/j.igie.2024.07.002","DOIUrl":"10.1016/j.igie.2024.07.002","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 445-446"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Skeletal muscle status may affect clinical outcomes of a variety of pancreatic diseases. Skeletal muscle quality and quantity have not been fully examined in relation to the outcomes of EUS-guided treatment of pancreatic fluid collections (PFCs).
Methods
Using a multi-institutional cohort of 372 patients receiving EUS-guided treatment of PFCs in 2010 to 2020, we examined the association of skeletal muscle status with adverse outcomes, including clinical treatment failure and in-hospital mortality. We used an in-house deep learning–based platform for preprocedural CT images, and skeletal muscle density (SMD) and skeletal muscle index (SMI; height-adjusted muscle area) were calculated as surrogates for muscular quality and quantity, respectively. Multivariable logistic regression analysis was conducted to calculate odds ratios (ORs) for adverse outcomes.
Results
Lower-level SMD was associated with higher risks of clinical failure and in-hospital mortality (Ptrend < .001). The adjusted OR for clinical failure comparing the extreme quartiles was 3.64 (95% confidence interval, 1.52-8.72). Compared with patients in the top 2 quartiles, patients in the lowest quartile had an adjusted OR for in-hospital mortality of 12.4 (95% confidence interval, 3.43-44.8). No effect modification according to the PFC types on the SMD–outcome relationship (Pinteraction > .16) was observed. SMD was not associated with the risk of procedure-related adverse events or PFC recurrence. SMI was not associated with adverse outcomes (Ptrend > .39).
Conclusions
In patients with endoscopically managed PFCs, SMD (but not SMI) was associated with the risks of clinical failure and in-hospital mortality, supporting the prognostic role of skeletal muscle quality.
{"title":"Artificial intelligence–based skeletal muscle estimates and outcomes of EUS-guided treatment of pancreatic fluid collections","authors":"Mamoru Takenaka MD, PhD , Wataru Gonoi MD, PhD , Tatsuya Sato MD, PhD , Tomotaka Saito MD, PhD , Shouhei Hanaoka MD, PhD , Tsuyoshi Hamada MD, MPH, PhD , Shunsuke Omoto MD, PhD , Atsuhiro Masuda MD, PhD , Masahiro Tsujimae MD, PhD , Takuji Iwashita MD, PhD , Shinya Uemura MD, PhD , Shogo Ota MD , Hideyuki Shiomi MD, PhD , Toshio Fujisawa MD, PhD , Sho Takahashi MD, PhD , Saburo Matsubara MD, PhD , Kentaro Suda MD , Akinori Maruta MD, PhD , Kensaku Yoshida MD, PhD , Keisuke Iwata MD, PhD , Yuhei Iwasa","doi":"10.1016/j.igie.2024.06.006","DOIUrl":"10.1016/j.igie.2024.06.006","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Skeletal muscle status may affect clinical outcomes of a variety of pancreatic diseases. Skeletal muscle quality and quantity have not been fully examined in relation to the outcomes of EUS-guided treatment of pancreatic fluid collections (PFCs).</div></div><div><h3>Methods</h3><div>Using a multi-institutional cohort of 372 patients receiving EUS-guided treatment of PFCs in 2010 to 2020, we examined the association of skeletal muscle status with adverse outcomes, including clinical treatment failure and in-hospital mortality. We used an in-house deep learning–based platform for preprocedural CT images, and skeletal muscle density (SMD) and skeletal muscle index (SMI; height-adjusted muscle area) were calculated as surrogates for muscular quality and quantity, respectively. Multivariable logistic regression analysis was conducted to calculate odds ratios (ORs) for adverse outcomes.</div></div><div><h3>Results</h3><div>Lower-level SMD was associated with higher risks of clinical failure and in-hospital mortality (<em>P</em><sub>trend</sub> < .001). The adjusted OR for clinical failure comparing the extreme quartiles was 3.64 (95% confidence interval, 1.52-8.72). Compared with patients in the top 2 quartiles, patients in the lowest quartile had an adjusted OR for in-hospital mortality of 12.4 (95% confidence interval, 3.43-44.8). No effect modification according to the PFC types on the SMD–outcome relationship (<em>P</em><sub>interaction</sub> > .16) was observed. SMD was not associated with the risk of procedure-related adverse events or PFC recurrence. SMI was not associated with adverse outcomes (<em>P</em><sub>trend</sub> > .39).</div></div><div><h3>Conclusions</h3><div>In patients with endoscopically managed PFCs, SMD (but not SMI) was associated with the risks of clinical failure and in-hospital mortality, supporting the prognostic role of skeletal muscle quality.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 382-392.e8"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.igie.2024.07.003
Alexander Miller MD , Nima Kamalpour MD , Lynn F. Butterly MD , Joseph C. Anderson MD
Background and Aims
Women and older or thinner patients have lower colonoscopy cecal intubation rates. We used data from the New Hampshire Colonoscopy Registry (NHCR) to examine the association between these and other endoscopist factors and trends of colonoscopy cecal intubation rates.
Methods
Our sample included patients ≥40 years from the NHCR with an adequate bowel preparation. We examined colonoscopy completion rates over quartiles (2004-2011, 2012-2014, 2015-2017, and 2018-2021) as stratified by men versus women and body mass index (BMI). In addition to these factors, we also adjusted for age and year of examination. Other variables of interest were specialty of the endoscopist and adenoma detection rates (ADRs).
Results
Our sample included 143,095 individuals (52.5% women [n = 75,180]). Multivariable analysis showed that BMI <25 (odds ratio [OR], .87; 95% confidence interval [CI], .76-.99), obesity (BMI ≥30) (OR, .88; 95% CI, .77-.99), and older age (per year) (OR, .96; 95% CI, .96-.97) were associated with a decreased likelihood of having a complete colonoscopy. Men were more likely than women to have a higher completion rate (OR, 1.46; 95% CI, 1.30-1.63). Gastroenterology specialty (OR, 1.78; 95% CI, 1.56-2.03) and an ADR ≥25% (OR, 2.01; 95% CI, 1.79-2.26) were associated with an increased likelihood of cecal intubation. These endoscopist-related factors were also observed to be predictive of cecal intubation in a subset of thin (BMI <25) women. Men and obese patients (BMI ≥30) were more likely to have incomplete examinations halted in the right-sided versus left-sided colon.
Conclusions
Even after adjusting for endoscopist factors, our study demonstrated that older or female patients and those with a BMI <25 or ≥30 had lower colonoscopy completion rates. Our data also suggest that colonoscopies performed in thin women were more likely to be completed if they were performed by a gastroenterologist as opposed to a nongastroenterologist.
{"title":"Cecal intubation rates: data from the New Hampshire Colonoscopy Registry","authors":"Alexander Miller MD , Nima Kamalpour MD , Lynn F. Butterly MD , Joseph C. Anderson MD","doi":"10.1016/j.igie.2024.07.003","DOIUrl":"10.1016/j.igie.2024.07.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Women and older or thinner patients have lower colonoscopy cecal intubation rates. We used data from the New Hampshire Colonoscopy Registry (NHCR) to examine the association between these and other endoscopist factors and trends of colonoscopy cecal intubation rates.</div></div><div><h3>Methods</h3><div>Our sample included patients ≥40 years from the NHCR with an adequate bowel preparation. We examined colonoscopy completion rates over quartiles (2004-2011, 2012-2014, 2015-2017, and 2018-2021) as stratified by men versus women and body mass index (BMI). In addition to these factors, we also adjusted for age and year of examination. Other variables of interest were specialty of the endoscopist and adenoma detection rates (ADRs).</div></div><div><h3>Results</h3><div>Our sample included 143,095 individuals (52.5% women [n = 75,180]). Multivariable analysis showed that BMI <25 (odds ratio [OR], .87; 95% confidence interval [CI], .76-.99), obesity (BMI ≥30) (OR, .88; 95% CI, .77-.99), and older age (per year) (OR, .96; 95% CI, .96-.97) were associated with a decreased likelihood of having a complete colonoscopy. Men were more likely than women to have a higher completion rate (OR, 1.46; 95% CI, 1.30-1.63). Gastroenterology specialty (OR, 1.78; 95% CI, 1.56-2.03) and an ADR ≥25% (OR, 2.01; 95% CI, 1.79-2.26) were associated with an increased likelihood of cecal intubation. These endoscopist-related factors were also observed to be predictive of cecal intubation in a subset of thin (BMI <25) women. Men and obese patients (BMI ≥30) were more likely to have incomplete examinations halted in the right-sided versus left-sided colon.</div></div><div><h3>Conclusions</h3><div>Even after adjusting for endoscopist factors, our study demonstrated that older or female patients and those with a BMI <25 or ≥30 had lower colonoscopy completion rates. Our data also suggest that colonoscopies performed in thin women were more likely to be completed if they were performed by a gastroenterologist as opposed to a nongastroenterologist.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 393-400.e1"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.igie.2024.06.001
Shanshan Wang MD , Nan Lan PhD, MD , Bo Shen MD
Background and Aims
Duodenal stricturing in Crohn’s disease is rare, and its management has been challenging. Fibrotic or mixed inflammatory/fibrotic primary strictures of Crohn’s disease do not respond well to medical therapy, eventually requiring endoscopic or surgical intervention. Endoscopic balloon dilation has been considered a middle-of-the-road strategy between medical and surgical approaches but is limited by its efficacy in primary stricture, recurrence, and frequent need for redilation. To address these issues, novel strategies, including endoscopic stricturotomy and strictureplasty utilizing electroincision, have been developed. This study aimed to analyze the effectiveness and safety of endoscopic electroincision therapy in Crohn’s disease–related duodenal strictures in a small cohort of consecutive patients.
Methods
Data on patients diagnosed with Crohn’s disease and duodenal strictures who were treated with endoscopic electroincision were consecutively extracted from the interventional inflammatory bowel disease unit from December 2, 2019, to January 31 of 2024. All patients with anastomotic stricture were excluded from the study. The primary outcomes were surgery-free survival and postprocedural adverse events.
Results
Eight endoscopic electroincision therapies were performed in 5 patients for Crohn’s disease–induced duodenal stricture. The study found a technical success rate of 88%, and a clinical response rate of 100%. The adverse event rate was unremarkable. The rate of endoscopic retreatment was 60%, with a minimum 6-month interval. In follow-up, no patient required surgical intervention.
Conclusions
Both endoscopic stricturotomy and strictureplasty seem to be effective and safe therapeutic modalities for Crohn’s disease–associated duodenal stricture.
{"title":"Endoscopic stricturotomy and strictureplasty for Crohn’s disease–related duodenal strictures","authors":"Shanshan Wang MD , Nan Lan PhD, MD , Bo Shen MD","doi":"10.1016/j.igie.2024.06.001","DOIUrl":"10.1016/j.igie.2024.06.001","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Duodenal stricturing in Crohn’s disease is rare, and its management has been challenging. Fibrotic or mixed inflammatory/fibrotic primary strictures of Crohn’s disease do not respond well to medical therapy, eventually requiring endoscopic or surgical intervention. Endoscopic balloon dilation has been considered a middle-of-the-road strategy between medical and surgical approaches but is limited by its efficacy in primary stricture, recurrence, and frequent need for redilation. To address these issues, novel strategies, including endoscopic stricturotomy and strictureplasty utilizing electroincision, have been developed. This study aimed to analyze the effectiveness and safety of endoscopic electroincision therapy in Crohn’s disease–related duodenal strictures in a small cohort of consecutive patients.</div></div><div><h3>Methods</h3><div>Data on patients diagnosed with Crohn’s disease and duodenal strictures who were treated with endoscopic electroincision were consecutively extracted from the interventional inflammatory bowel disease unit from December 2, 2019, to January 31 of 2024. All patients with anastomotic stricture were excluded from the study. The primary outcomes were surgery-free survival and postprocedural adverse events.</div></div><div><h3>Results</h3><div>Eight endoscopic electroincision therapies were performed in 5 patients for Crohn’s disease–induced duodenal stricture. The study found a technical success rate of 88%, and a clinical response rate of 100%. The adverse event rate was unremarkable. The rate of endoscopic retreatment was 60%, with a minimum 6-month interval. In follow-up, no patient required surgical intervention.</div></div><div><h3>Conclusions</h3><div>Both endoscopic stricturotomy and strictureplasty seem to be effective and safe therapeutic modalities for Crohn’s disease–associated duodenal stricture.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 342-345"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.igie.2024.07.004
Azizullah Beran MD , Mouhand F. Mohamed MD , John J. Guardiola MD , Tarek Aboursheid MD , Alejandra Vargas MD , Tarek Nayfeh MD , Khaled Elfert MD , Mohammad Shaear MD , Hala Fatima MD , Jeffrey J. Easler MD , Mohammad Al-Haddad MD , Nabil Fayad MD , Patrick Young MD , Samir A. Shah MD , Douglas K. Rex MD
Background and Aims
Gastroenterologists are at risk for endoscopy-related injury (ERI). The aim of this meta-analysis was to assess the prevalence, characteristics, and burden of ERI.
Methods
We searched PubMed, EMBASE, and Web of Science databases for studies reporting ERI prevalence among GI endoscopists. The primary outcome was the pooled ERI prevalence. We also assessed ERI types and treatments. We compared ERI based on sex. Finally, we compared musculoskeletal injury (MSI) prevalence between GI endoscopists and nonendoscopists. The pooled rates were generated using a proportion meta-analysis with the random-effects model. Prevalence ratios (PRs) with the corresponding confidence intervals (CIs) were used for comparative data.
Results
We included 26 studies with 6246 endoscopists. Overall, ERI prevalence was 67.9% (95% CI, 60.7-74.4). ERI prevalence in advanced endoscopists was 77.8% (95% CI, 55.1-90.9). A higher trend of ERI prevalence was observed in more recent studies (after 2015) (71.7%; 95% CI, 63.3-78.9). Neck pain (36.7%) was the most common ERI, followed by low back pain (35.6%) and thumb pain (33.1%). Although women reported higher incidences of De Quervain tenosynovitis and carpal tunnel syndrome and wrist, thumb, shoulder, and neck pain, men reported higher incidences of elbow pain. GI endoscopists had a higher MSI prevalence than nonendoscopists (PR, 1.56; 95% CI, 1.01-2.41). Female endoscopists reported higher ERIs (PR, 1.21; 95% CI, 1.10-1.32). Only 19.1% of endoscopists reported receiving prior ergonomic training.
Conclusions
ERI is increasingly prevalent in gastroenterology, particularly in female gastroenterologists with significant sex disparities in ERI types noted. These findings underscore the significance of incorporating ergonomic principles into gastroenterology practices to mitigate ERI risks, particularly considering the shortage of gastroenterologists.
背景和目的消化内科医生面临内镜相关损伤（ERI）的风险。本荟萃分析旨在评估 ERI 的患病率、特征和负担。方法我们检索了 PubMed、EMBASE 和 Web of Science 数据库中报告消化内镜医师 ERI 患病率的研究。研究的主要结果是ERI的总发病率。我们还评估了ERI的类型和治疗方法。我们比较了基于性别的 ERI。最后，我们比较了消化道内镜医师和非内镜医师的肌肉骨骼损伤 (MSI) 发生率。采用随机效应模型进行比例荟萃分析，得出汇总率。结果我们纳入了 26 项研究，共有 6246 名内镜医师参与。总体而言，ERI 患病率为 67.9%（95% CI，60.7-74.4）。高级内镜医师的ERI发生率为77.8%（95% CI，55.1-90.9）。最近的研究（2015 年以后）观察到 ERI 患病率呈上升趋势（71.7%；95% CI，63.3-78.9）。颈痛（36.7%）是最常见的 ERI，其次是腰背痛（35.6%）和拇指痛（33.1%）。虽然女性报告的杜氏腱鞘炎和腕管综合征以及腕部、拇指、肩部和颈部疼痛发生率较高，但男性报告的肘部疼痛发生率较高。消化内镜医师的 MSI 患病率高于非内镜医师（PR，1.56；95% CI，1.01-2.41）。女性内镜医师的ERI较高（PR，1.21；95% CI，1.10-1.32）。结论 ERI 在消化内科越来越普遍，尤其是在女性消化内科医生中，ERI 类型的性别差异显著。这些发现强调了将人体工程学原理纳入消化内科实践以降低ERI风险的重要性，特别是考虑到消化内科医生的短缺问题。
{"title":"Prevalence and sex differences in endoscopy-related injuries: comprehensive systematic review and meta-analysis","authors":"Azizullah Beran MD , Mouhand F. Mohamed MD , John J. Guardiola MD , Tarek Aboursheid MD , Alejandra Vargas MD , Tarek Nayfeh MD , Khaled Elfert MD , Mohammad Shaear MD , Hala Fatima MD , Jeffrey J. Easler MD , Mohammad Al-Haddad MD , Nabil Fayad MD , Patrick Young MD , Samir A. Shah MD , Douglas K. Rex MD","doi":"10.1016/j.igie.2024.07.004","DOIUrl":"10.1016/j.igie.2024.07.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Gastroenterologists are at risk for endoscopy-related injury (ERI). The aim of this meta-analysis was to assess the prevalence, characteristics, and burden of ERI.</div></div><div><h3>Methods</h3><div>We searched PubMed, EMBASE, and Web of Science databases for studies reporting ERI prevalence among GI endoscopists. The primary outcome was the pooled ERI prevalence. We also assessed ERI types and treatments. We compared ERI based on sex. Finally, we compared musculoskeletal injury (MSI) prevalence between GI endoscopists and nonendoscopists. The pooled rates were generated using a proportion meta-analysis with the random-effects model. Prevalence ratios (PRs) with the corresponding confidence intervals (CIs) were used for comparative data.</div></div><div><h3>Results</h3><div>We included 26 studies with 6246 endoscopists. Overall, ERI prevalence was 67.9% (95% CI, 60.7-74.4). ERI prevalence in advanced endoscopists was 77.8% (95% CI, 55.1-90.9). A higher trend of ERI prevalence was observed in more recent studies (after 2015) (71.7%; 95% CI, 63.3-78.9). Neck pain (36.7%) was the most common ERI, followed by low back pain (35.6%) and thumb pain (33.1%). Although women reported higher incidences of De Quervain tenosynovitis and carpal tunnel syndrome and wrist, thumb, shoulder, and neck pain, men reported higher incidences of elbow pain. GI endoscopists had a higher MSI prevalence than nonendoscopists (PR, 1.56; 95% CI, 1.01-2.41). Female endoscopists reported higher ERIs (PR, 1.21; 95% CI, 1.10-1.32). Only 19.1% of endoscopists reported receiving prior ergonomic training.</div></div><div><h3>Conclusions</h3><div>ERI is increasingly prevalent in gastroenterology, particularly in female gastroenterologists with significant sex disparities in ERI types noted. These findings underscore the significance of incorporating ergonomic principles into gastroenterology practices to mitigate ERI risks, particularly considering the shortage of gastroenterologists.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 401-412.e22"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141838806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.igie.2024.06.003
the American Society for Gastrointestinal Endoscopy Technology Committee, Samuel Han MD, MS , Mohit Girotra MD, FASGE , Maaza Abdi MD , Venkata S. Akshintala MD , Dennis Chen MD , Yen-I Chen MD , Koushik K. Das MD, FASGE , David J. Desilets MD, PhD, FASGE , Daniela Guerrero Vinsard MD , Galen Leung MD , Girish Mishra MD, MSc, FASGE , V. Raman Muthusamy MD, MAS , Frances U. Onyimba MD , Swati Pawa MD, FASGE , Tarun Rustagi MD , Sonali Sakaria MD , Nikrad Shahnavaz MD , Ryan J. Law DO
{"title":"Endoscopic vacuum therapy","authors":"the American Society for Gastrointestinal Endoscopy Technology Committee, Samuel Han MD, MS , Mohit Girotra MD, FASGE , Maaza Abdi MD , Venkata S. Akshintala MD , Dennis Chen MD , Yen-I Chen MD , Koushik K. Das MD, FASGE , David J. Desilets MD, PhD, FASGE , Daniela Guerrero Vinsard MD , Galen Leung MD , Girish Mishra MD, MSc, FASGE , V. Raman Muthusamy MD, MAS , Frances U. Onyimba MD , Swati Pawa MD, FASGE , Tarun Rustagi MD , Sonali Sakaria MD , Nikrad Shahnavaz MD , Ryan J. Law DO","doi":"10.1016/j.igie.2024.06.003","DOIUrl":"10.1016/j.igie.2024.06.003","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 333-341"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142420667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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