iGIE最新文献

英文中文

Neural ablation as a mechanism of action for antral myotomy in the treatment of obesity 将神经消融作为窦前肌切开术治疗肥胖症的作用机制

iGIE

Pub Date : 2024-09-01 DOI: 10.1016/j.igie.2024.07.006

Pichamol Jirapinyo MD, MPH, Christopher C. Thompson MD, MSc, Sohail Shaikh MD, Nitin Kumar MD

引用次数: 0

Outcomes of phosphorus-32 microparticle intratumoral implantation added to chemotherapy in patients with metastatic pancreatic adenocarcinoma 磷-32（32P）微粒子瘤内植入与化疗相结合治疗转移性胰腺腺癌患者的疗效

iGIE

Pub Date : 2024-09-01 DOI: 10.1016/j.igie.2024.06.005

Amanda Huoy Wen Lim MBBS, FRACP, MMedStats , Nimit Singhal MBBS, FRACP , Dylan Bartholomeusz MBBS, FRACP, PhD , Joshua Zobel BMedSc, GradDipBiostats , Jeevinesh Naidu MB ChB, MRCP , William Hsieh BPharmSc , Benjamin Crouch BSc(Hons), MPhil , Harpreet Wasan MBBS, MRCP , Daniel Croagh MBBS, PhD, FRACS , Adnan Nagrial MBBS, FRACP, PhD , Morteza Aghmesheh MBBS, FRACP, PhD , Edmund Tse MBBS, FRACP, PhD , Christopher K. Rayner MBBS, FRACP, PhD , Nam Quoc Nguyen MBBS, FRACP, PhD

Background and Aims

Metastatic pancreatic ductal adenocarcinoma (mPDAC) has a 5-year survival rate of 3%. In nonmetastatic, locally advanced pancreatic cancer, the addition to chemotherapy of EUS-guided intratumoral phosphorus-32 (³²P) microparticle implantation has achieved good local disease control. The aim of this study was to report the clinical outcomes of this treatment in patients with mPDAC.

Methods

Patients with mPDAC treated with chemotherapy and intratumoral ³²P-microparticles from 5 centers in Australia and the United Kingdom were analyzed retrospectively.

Results

Fourteen patients were treated (7 female subjects; median age, 64.5 years; Eastern Cooperative Oncology Group performance status scores 0/1/2, 21.4%/57.1%/21.4%). The median baseline primary tumor longest diameter was 40.5 mm. Patients had a median of 3 metastases (interquartile range, 2.25 to 5) and received either 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (n = 4) or gemcitabine/nab-paclitaxel (n = 10). ³²P microparticles were implanted at a median 3.1 months from chemotherapy commencement. Local disease control rate at 3 months’ postimplantation was 100%. Primary tumor longest diameter decreased by 25% (interquartile range, –31.4% to –16.7%; P = .008), and serum cancer antigen 19-9 levels declined from 134 U/mL to 66 U/mL (P = .018). Local progression-free survival was 12.2 months (95% CI, 9.0-15.4 months) from chemotherapy commencement and 8.3 months (95% CI, 2.6-16.0 months) from ³²P microparticle implantation. Therapy was associated with improved quality of life, including global health status at 12 weeks’ postimplantation (P = .037). Median overall survival was 13.8 months (95% CI, 10.5-17.1 months) from chemotherapy commencement and 11 months (95% CI, 5.6-17.4 months) from ³²P microparticle implantation. No grade 4/5 acute toxicities were observed.

Conclusions

This first multicenter analysis of combined chemotherapy and EUS-guided ³²P microparticle implantation in mPDAC shows the potential clinical benefits of local tumor control in a cohort for whom outcomes are historically poor.

背景和目的转移性胰腺导管腺癌（mPDAC）的5年生存率仅为3%。对于非转移性、局部晚期胰腺癌，在化疗的基础上加用 EUS 引导的瘤内磷-32（32P）微粒子植入治疗，可取得良好的局部疾病控制效果。方法回顾性分析澳大利亚和英国 5 个中心接受化疗和腔内 32P 微粒治疗的 mPDAC 患者。结果14 名患者接受了治疗（7 名女性；中位年龄 64.5 岁；东部合作肿瘤学组表现状态评分 0/1/2 分，21.4%/57.1%/21.4%）。基线原发肿瘤最长直径的中位数为 40.5 毫米。患者的中位转移灶为3个（四分位间范围为2.25至5个），接受了5-氟尿嘧啶、亮菌素、伊立替康和奥沙利铂治疗（4例）或吉西他滨/纳布-紫杉醇治疗（10例）。32P微粒在化疗开始后的中位 3.1 个月植入。植入后3个月的局部疾病控制率为100%。原发肿瘤最长直径缩小了25%（四分位间范围为-31.4%至-16.7%；P = .008），血清癌抗原19-9水平从134 U/mL降至66 U/mL（P = .018）。局部无进展生存期为化疗开始后 12.2 个月（95% CI，9.0-15.4 个月），32P 微粒子植入后 8.3 个月（95% CI，2.6-16.0 个月）。治疗与生活质量的改善有关，包括植入后12周的总体健康状况（P = 0.037）。中位总生存期为化疗开始后13.8个月（95% CI，10.5-17.1个月），32P微粒植入后11个月（95% CI，5.6-17.4个月）。结论这是首次对mPDAC患者进行联合化疗和EUS引导下32P微粒植入的多中心分析，显示了局部肿瘤控制的潜在临床益处，而这一人群的治疗效果历来不佳。

{"title":"Outcomes of phosphorus-32 microparticle intratumoral implantation added to chemotherapy in patients with metastatic pancreatic adenocarcinoma","authors":"Amanda Huoy Wen Lim MBBS, FRACP, MMedStats , Nimit Singhal MBBS, FRACP , Dylan Bartholomeusz MBBS, FRACP, PhD , Joshua Zobel BMedSc, GradDipBiostats , Jeevinesh Naidu MB ChB, MRCP , William Hsieh BPharmSc , Benjamin Crouch BSc(Hons), MPhil , Harpreet Wasan MBBS, MRCP , Daniel Croagh MBBS, PhD, FRACS , Adnan Nagrial MBBS, FRACP, PhD , Morteza Aghmesheh MBBS, FRACP, PhD , Edmund Tse MBBS, FRACP, PhD , Christopher K. Rayner MBBS, FRACP, PhD , Nam Quoc Nguyen MBBS, FRACP, PhD","doi":"10.1016/j.igie.2024.06.005","DOIUrl":"10.1016/j.igie.2024.06.005","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Metastatic pancreatic ductal adenocarcinoma (mPDAC) has a 5-year survival rate of 3%. In nonmetastatic, locally advanced pancreatic cancer, the addition to chemotherapy of EUS-guided intratumoral phosphorus-32 (<sup>32</sup>P) microparticle implantation has achieved good local disease control. The aim of this study was to report the clinical outcomes of this treatment in patients with mPDAC.</div></div><div><h3>Methods</h3><div>Patients with mPDAC treated with chemotherapy and intratumoral <sup>32</sup>P-microparticles from 5 centers in Australia and the United Kingdom were analyzed retrospectively.</div></div><div><h3>Results</h3><div>Fourteen patients were treated (7 female subjects; median age, 64.5 years; Eastern Cooperative Oncology Group performance status scores 0/1/2, 21.4%/57.1%/21.4%). The median baseline primary tumor longest diameter was 40.5 mm. Patients had a median of 3 metastases (interquartile range, 2.25 to 5) and received either 5-fluorouracil, leucovorin, irinotecan, and oxaliplatin (n = 4) or gemcitabine/nab-paclitaxel (n = 10). <sup>32</sup>P microparticles were implanted at a median 3.1 months from chemotherapy commencement. Local disease control rate at 3 months’ postimplantation was 100%. Primary tumor longest diameter decreased by 25% (interquartile range, –31.4% to –16.7%; <em>P</em> = .008), and serum cancer antigen 19-9 levels declined from 134 U/mL to 66 U/mL (<em>P</em> = .018). Local progression-free survival was 12.2 months (95% CI, 9.0-15.4 months) from chemotherapy commencement and 8.3 months (95% CI, 2.6-16.0 months) from <sup>32</sup>P microparticle implantation. Therapy was associated with improved quality of life, including global health status at 12 weeks’ postimplantation (<em>P</em> = .037). Median overall survival was 13.8 months (95% CI, 10.5-17.1 months) from chemotherapy commencement and 11 months (95% CI, 5.6-17.4 months) from <sup>32</sup>P microparticle implantation. No grade 4/5 acute toxicities were observed.</div></div><div><h3>Conclusions</h3><div>This first multicenter analysis of combined chemotherapy and EUS-guided <sup>32</sup>P microparticle implantation in mPDAC shows the potential clinical benefits of local tumor control in a cohort for whom outcomes are historically poor.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 3","pages":"Pages 373-381"},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692630","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}

引用次数: 0

Effects of hard candy on saliva production and gastric fluid volume: implications for safe endoscopy 硬糖对唾液分泌和胃液量的影响：对安全内镜检查的影响

iGIE

Pub Date : 2024-09-01 DOI: 10.1016/j.igie.2024.07.008

Saleh Alghsoon MD , Madeline Alizadeh PhD , William H Scott, MA , Guofeng Xie MD , Jean-Pierre Raufman MD , Erik C. von Rosenvinge MD

Background and Aims

Patients presenting for endoscopic procedures consuming or having recently consumed hard candy may have their procedures delayed or canceled because of concern for aspiration. Our aim is to determine the time needed after ingestion of hard candy for the safe performance of sedated endoscopy.

Methods

A 2-phase institutional review board–approved study was performed. In phase 1, healthy adults collected their oral secretions before and after ingestion of hard candy to measure the impact of hard candy on saliva production. In phase 2, patients undergoing clinical upper endoscopy were randomized to receive hard candy (HC group) or not receive hard candy (no-HC group) approximately 30 minutes before endoscopy. Blinded endoscopists aspirated gastric fluid immediately after gastric intubation and measured its volume and weight. Participants were assessed for adverse events.

Results

Ten healthy volunteers (6 women; median age, 28 years) were enrolled in phase 1. Saliva production peaked at the collection 10 minutes after initiating hard candy. The mean time from candy completion for saliva production to return to within 10% of unstimulated levels was 32 minutes (standard deviation, 12). In phase 2, 63 participants were randomized and had gastric fluid volumes and weights measured. The mean gastric fluid volume was 23.3 mL in the HC group and 17.6 mL in the no-HC group (P = .21). No adverse events were attributable to study participation.

Conclusions

Our results suggest that endoscopic procedures can be safely performed after ingestion of hard candy and should not be delayed by more than 30 minutes.

背景和目的患者在进行内窥镜手术时食用或刚食用过硬糖，可能会因担心吸入而推迟或取消手术。我们的目的是确定摄入硬糖后安全进行镇静内镜检查所需的时间。在第一阶段，健康成年人在摄入硬糖前后收集口腔分泌物，以测量硬糖对唾液分泌的影响。在第二阶段，接受临床上消化道内窥镜检查的患者在内窥镜检查前约 30 分钟被随机分为接受硬糖组（HC 组）和不接受硬糖组（no-HC 组）。盲法内镜医师在插胃管后立即抽吸胃液，并测量其体积和重量。第一阶段共招募了 10 名健康志愿者（6 名女性；中位年龄 28 岁）。开始食用硬糖 10 分钟后，唾液分泌达到高峰。从吃完糖果到唾液分泌量恢复到未受刺激水平的 10% 以内的平均时间为 32 分钟（标准偏差为 12）。在第二阶段，63 名参与者被随机分配，并测量了胃液量和体重。HC组的平均胃液量为23.3毫升，无HC组为17.6毫升（P = .21）。结论我们的研究结果表明，在摄入硬糖后可以安全地进行内窥镜手术，延迟时间不应超过 30 分钟。

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引用次数: 0

Unveiling a rare adverse event: sponge migration during endoscopic vacuum therapy for colorectal anastomotic leak 揭开罕见不良事件的面纱：内窥镜真空疗法治疗结直肠吻合口漏时的海绵移位

iGIE

Pub Date : 2024-09-01 DOI: 10.1016/j.igie.2024.02.005

引用次数: 0

Peroral cholecystoscopy–guided interventions through a lumen-apposing metal stent after EUS-guided gallbladder drainage: proof-of-concept study in a swine model 在内镜超声引导下进行胆囊引流术后，通过腔隙贴合金属支架进行口周胆囊镜引导介入治疗：猪模型概念验证研究

iGIE

Pub Date : 2024-09-01 DOI: 10.1016/j.igie.2024.07.001

Naminatsu Takahara MD, PhD , Yousuke Nakai MD, PhD , Tatsuya Sato MD, PhD , Ryunosuke Hakuta MD, PhD , Hiroki Oyama MD, PhD , Kensaku Noguchi MD, PhD , Tatsunori Suzuki MD, PhD , Kazunaga Ishigaki MD, PhD , Tomotaka Saito MD, PhD , Tsuyoshi Hamada MD, MPH, PhD , Mitsuhiro Fujishiro MD, PhD

Background and Aims

EUS-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS), originally developed as drainage for cholecystitis, enables endoscopic access into the gallbladder lumen. However, few studies have investigated the feasibility of peroral cholecystoscopy (POCCS)-guided interventions through a LAMS.

Methods

EUS-GBD using a LAMS followed by POCCS-guided interventions were performed in 4 swine. Technical success, safety, and feasibility of POCCS visualization and POCCS-guided biopsy sampling and mucosal resection through the LAMS immediately and 3 weeks after EUS-GBD were investigated. Additionally, all specimens including necropsy were pathologically evaluated.

Results

POCCS and target biopsy sampling were successful through the LAMS in all swine immediately after EUS-GBD, without any adverse events. POCCS-guided biopsy sampling and mucosal resection 3 weeks after EUS-GBD were technically feasible and pathologically assessable in all swine. The necropsy specimens displayed hyperplastic and inflammatory changes in the gallbladder and nearby organs after 3 weeks of EUS-GBD.

Conclusions

POCCS-guided interventions including mucosal resection were technically feasible through a LAMS after EUS-GBD.

背景和目的使用腔隙贴合金属支架（LAMS）的超声引导胆囊引流术（EUS-GBD）最初是作为胆囊炎的引流而开发的，它能使内镜进入胆囊腔。然而，很少有研究调查了在经口胆囊镜（POCCS）引导下通过 LAMS 进行介入治疗的可行性。方法在 4 头猪身上进行了使用 LAMS 的 EUS-GBD 和 POCCS 引导下的介入治疗。研究调查了 POCCS 可视化和 POCCS 引导下通过 LAMS 在 EUS-GBD 后立即和 3 周进行活检取样和粘膜切除的技术成功率、安全性和可行性。此外，还对包括尸体解剖在内的所有标本进行了病理评估。结果所有猪在 EUS-GBD 术后立即通过 LAMS 成功进行了 POCCS 和目标活检取样，未发生任何不良事件。所有猪在 EUS-GBD 3 周后在 POCCS 引导下进行活检取样和粘膜切除在技术上是可行的，病理学上也可进行评估。结论在 EUS-GBD 3 周后，通过 LAMS 进行包括粘膜切除在内的 POCCS 引导干预在技术上是可行的。

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引用次数: 0

Endoscopic treatment of nonoperable large postsurgical esophageal fistulas: retrospective analysis of a single tertiary center cohort 无法手术的大型术后食管瘘的内窥镜治疗：对一个三级中心队列的回顾性分析

iGIE

Pub Date : 2024-06-01 DOI: 10.1016/j.igie.2024.03.001

Sebastian Petruzzella MSc , Elodie Romailler MD , Thomas Greuter PD, MD , Sarra Oumrani MD , Domenico Galasso MD , Maxime Robert MD , Styliani Mantziari PD, MD , Markus Schäfer Pr, MD , Sébastien Godat PD, MD

Background and Aims

Anastomotic fistulas are a frequent and dreaded adverse event of esophagectomy. Endoscopic therapy using different techniques is now a well-established first-line treatment option. The aim of our study was to evaluate the efficacy of such endoscopic treatments in patients not fit for surgical reintervention and particularly in cases of major tissue defects of >10 mm.

Methods

Fifty-seven patients with postoperative large esophageal fistulas who were not considered for surgical reintervention were retrospectively analyzed after undergoing treatment with different endoscopic techniques in a single tertiary center. The primary endpoint was to evaluate the technical and clinical efficacy of endoscopic treatments of those fistulas. The secondary endpoint was to evaluate the endoscopic treatment–related adverse events.

Results

In 94.7% of patients (n = 54), the intervention was effectively carried out from a technical point of view. In 77.2% of patients (n = 44), treatment led to successful complete closure of the fistula. If we consider the 54 patients in whom technical success was reached, in 75.9% of them (n = 41), clinical success with complete closure of the fistula was achieved. Minor adverse events related to the procedure occurred in 26.32% of patients (n = 15) and major adverse events in 8.8% (n = 5). The mortality rate related to the procedure was 3.5% (n = 2).

Conclusions

Endoscopic treatment is a technically achievable, highly effective way of treating postoperative large esophageal fistulas in patients who were not considered fit for surgical treatment, including major defects of >10 mm. It allows patients with a high risk of rapid deterioration to safely recover from their condition, avoiding severe and fatal adverse events without having to resort to debilitating surgical treatment.

背景和目的食管瘘是食管切除术中一种常见且可怕的不良反应。目前，采用不同技术的内镜疗法已成为公认的一线治疗方案。我们研究的目的是评估此类内镜疗法对不适合手术再介入的患者，尤其是对组织缺损达 10 毫米的患者的疗效。方法在一家三级医院对 57 例术后出现食管大瘘管且不考虑手术再介入的患者进行了回顾性分析，这些患者在接受了不同内镜技术的治疗后出现了食管大瘘管。主要终点是评估内窥镜治疗这些瘘管的技术和临床疗效。结果94.7%的患者（54 人）从技术角度看有效地进行了干预，77.2%的患者（54 人）从技术角度看有效地进行了干预，77.2%的患者（54 人）从技术角度看有效地进行了干预。77.2%的患者（44 人）通过治疗成功实现了瘘管的完全闭合。如果考虑到技术成功的 54 例患者，其中 75.9% 的患者（n = 41）实现了瘘管完全闭合的临床成功。与手术相关的轻微不良反应发生率为 26.32%（15 例），重大不良反应发生率为 8.8%（5 例）。结论内窥镜治疗是一种技术上可行、高效的方法，可用于治疗不适合手术治疗的患者术后大食管瘘，包括 10 毫米的大缺损。它能让病情极有可能迅速恶化的患者安全康复，避免严重和致命的不良事件，而不必诉诸使人衰弱的手术治疗。

{"title":"Endoscopic treatment of nonoperable large postsurgical esophageal fistulas: retrospective analysis of a single tertiary center cohort","authors":"Sebastian Petruzzella MSc , Elodie Romailler MD , Thomas Greuter PD, MD , Sarra Oumrani MD , Domenico Galasso MD , Maxime Robert MD , Styliani Mantziari PD, MD , Markus Schäfer Pr, MD , Sébastien Godat PD, MD","doi":"10.1016/j.igie.2024.03.001","DOIUrl":"10.1016/j.igie.2024.03.001","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Anastomotic fistulas are a frequent and dreaded adverse event of esophagectomy. Endoscopic therapy using different techniques is now a well-established first-line treatment option. The aim of our study was to evaluate the efficacy of such endoscopic treatments in patients not fit for surgical reintervention and particularly in cases of major tissue defects of >10 mm.</p></div><div><h3>Methods</h3><p>Fifty-seven patients with postoperative large esophageal fistulas who were not considered for surgical reintervention were retrospectively analyzed after undergoing treatment with different endoscopic techniques in a single tertiary center. The primary endpoint was to evaluate the technical and clinical efficacy of endoscopic treatments of those fistulas. The secondary endpoint was to evaluate the endoscopic treatment–related adverse events.</p></div><div><h3>Results</h3><p>In 94.7% of patients (n = 54), the intervention was effectively carried out from a technical point of view. In 77.2% of patients (n = 44), treatment led to successful complete closure of the fistula. If we consider the 54 patients in whom technical success was reached, in 75.9% of them (n = 41), clinical success with complete closure of the fistula was achieved. Minor adverse events related to the procedure occurred in 26.32% of patients (n = 15) and major adverse events in 8.8% (n = 5). The mortality rate related to the procedure was 3.5% (n = 2).</p></div><div><h3>Conclusions</h3><p>Endoscopic treatment is a technically achievable, highly effective way of treating postoperative large esophageal fistulas in patients who were not considered fit for surgical treatment, including major defects of >10 mm. It allows patients with a high risk of rapid deterioration to safely recover from their condition, avoiding severe and fatal adverse events without having to resort to debilitating surgical treatment.</p></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 210-215"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000323/pdfft?md5=0f63d84c92f64e8254998570e11639c3&pid=1-s2.0-S2949708624000323-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399189","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}

引用次数: 0

Retrograde balloon pull-through technique for benign esophageal strictures: a single-center pilot experience 逆行球囊拉通技术治疗良性食管狭窄：单中心试点经验--（附视频）

iGIE

Pub Date : 2024-06-01 DOI: 10.1016/j.igie.2024.03.002

Shae Patel DO , Andrew Wright MD , Paul Leonor MD , Wasseem Skef MD

Background and Aims

Antegrade savary dilation and static balloon dilation are the mainstays of management of simple and complex benign esophageal strictures (BESs). A modified technique, termed retrograde balloon dilation, has potential advantages for the management of BESs. Efficacy and safety data on this technique are limited. We report a single-center experience of retrograde balloon dilation for BESs.

Methods

We conducted a retrospective study evaluating retrograde balloon and antegrade savary dilation for BESs in 53 unique patients who met inclusion criteria, including 23 undergoing a retrograde balloon pull-through technique and 30 undergoing antegrade savary dilation. The primary endpoint was technical success, defined as achieving a luminal diameter of ≥16 mm. Secondary endpoints were repeat dilation rates within 1 year after achieving therapeutic endpoint dilation and adverse events.

Results

Technical success was achieved in 22 of 23 patients (95.7%) with the retrograde balloon pull-through technique and in all 30 patients (100%) with antegrade savary dilation (P = .434). A nonsignificant trend of lower repeat dilation rates was present for the retrograde balloon pull-through group, with 4 of 22 in the retrograde balloon pull-through group versus 12 of 30 in the antegrade savary dilation group (P = .076). Only 1 minor adverse event occurred in the retrograde balloon pull-through group.

Conclusions

Our experience suggests that retrograde balloon pull-through dilation is effective and safe for simple and complex benign esophageal stenosis.

背景和目的逆行食管扩张术和静态球囊扩张术是治疗简单和复杂良性食管狭窄（BES）的主要方法。一种被称为逆行球囊扩张术的改良技术在治疗食管良性狭窄方面具有潜在优势。有关这种技术的有效性和安全性数据还很有限。我们进行了一项回顾性研究，评估了符合纳入标准的 53 名患者的逆行球囊和前向 savary 扩张术治疗 BES 的效果，其中 23 人接受了逆行球囊拉通技术，30 人接受了前向 savary 扩张术。主要终点是技术成功率，即管腔直径≥16 毫米。结果采用逆行球囊拉通技术的 23 例患者中有 22 例（95.7%）获得了技术成功，而采用顺行球囊扩张术的 30 例患者全部（100%）获得了技术成功（P = .434）。逆行球囊拉通组重复扩张率较低的趋势并不显著，逆行球囊拉通组 22 例中有 4 例重复扩张，而逆行球囊拉通组 30 例中有 12 例重复扩张（P = 0.076）。结论我们的经验表明，逆行球囊拉通扩张术对简单和复杂的良性食管狭窄有效且安全。

{"title":"Retrograde balloon pull-through technique for benign esophageal strictures: a single-center pilot experience","authors":"Shae Patel DO , Andrew Wright MD , Paul Leonor MD , Wasseem Skef MD","doi":"10.1016/j.igie.2024.03.002","DOIUrl":"10.1016/j.igie.2024.03.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Antegrade savary dilation and static balloon dilation are the mainstays of management of simple and complex benign esophageal strictures (BESs). A modified technique, termed retrograde balloon dilation, has potential advantages for the management of BESs. Efficacy and safety data on this technique are limited. We report a single-center experience of retrograde balloon dilation for BESs.</p></div><div><h3>Methods</h3><p>We conducted a retrospective study evaluating retrograde balloon and antegrade savary dilation for BESs in 53 unique patients who met inclusion criteria, including 23 undergoing a retrograde balloon pull-through technique and 30 undergoing antegrade savary dilation. The primary endpoint was technical success, defined as achieving a luminal diameter of ≥16 mm. Secondary endpoints were repeat dilation rates within 1 year after achieving therapeutic endpoint dilation and adverse events.</p></div><div><h3>Results</h3><p>Technical success was achieved in 22 of 23 patients (95.7%) with the retrograde balloon pull-through technique and in all 30 patients (100%) with antegrade savary dilation (<em>P</em> = .434). A nonsignificant trend of lower repeat dilation rates was present for the retrograde balloon pull-through group, with 4 of 22 in the retrograde balloon pull-through group versus 12 of 30 in the antegrade savary dilation group (<em>P</em> = .076). Only 1 minor adverse event occurred in the retrograde balloon pull-through group.</p></div><div><h3>Conclusions</h3><p>Our experience suggests that retrograde balloon pull-through dilation is effective and safe for simple and complex benign esophageal stenosis.</p></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 216-221"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000335/pdfft?md5=c4083a9bc45686b3c4a5dcfe96b649ba&pid=1-s2.0-S2949708624000335-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407644","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}

引用次数: 0

Exploring human–artificial intelligence interactions in a negative pragmatic trial of computer-aided polyp detection 在计算机辅助息肉检测的负面实用性试验中探索人类与人工智能的相互作用

iGIE

Pub Date : 2024-06-01 DOI: 10.1016/j.igie.2024.04.016

Kate Watkins BS , Uri Ladabaum MD, MS , Esther Olsen MHA , Jonathan Hoogerbrug MBBS , Ajitha Mannalithara PhD , Yingjie Weng MHS , Blake Shaw MS , Roger Bohn PhD , Sara Singer MBA, PhD

Background and Aims

The progress of artificial intelligence (AI) in endoscopy is at a crossroads. The positive results of randomized controlled trials of computer-aided detection (CADe) have not been replicated in multiple pragmatic CADe trials, including ours. This gap between efficacy and effectiveness remains to be understood. We surveyed and interviewed our trial’s colonoscopists to gain insight into human-AI interactions.

Methods

We used a sequential, mixed-methodology design. After the trial, we administered Survey 1, focusing on attitudes and beliefs before and after trying CADe. The trial’s null results were disclosed, and we then administered Survey 2 and conducted open-ended interviews, focusing on reactions to the null results. Responses were analyzed overall and by baseline adenoma detection rate (ADR) tertile. We identified key themes using thematic analysis and qualitative software.

Results

Nearly all colonoscopists responded (22 and 21 of 24 [92% and 88%] for Surveys 1 and 2, respectively). Most (96%) regarded endoscopic ability as critical to their professional identity. Large majorities conveyed trust in and enthusiasm for AI before and after trying CADe (82%-87%) and desired to have CADe available (72%). Nearly two-thirds (62%) were surprised by the null results. There were few differences by ADR. No unifying explanation for the null results emerged from surveys or individual interviews. Colonoscopists expressed a range of expectations for AI in endoscopy.

Conclusions

Lack of enthusiasm or mistrust of AI/CADe do not explain our pragmatic CADe trial’s null results. AI may need to target dimensions beyond optical recognition to realize its promise in endoscopy.

背景和目的人工智能（AI）在内窥镜检查领域的发展正处于十字路口。计算机辅助检测（CADe）随机对照试验的积极结果并未在包括我们在内的多项实用 CADe 试验中得到复制。疗效和有效性之间的差距仍有待了解。我们对试验中的结肠镜医师进行了调查和访谈，以深入了解人类与人工智能之间的互动。试验结束后，我们进行了调查 1，重点了解试用 CADe 前后的态度和信念。试验的无效结果公布后，我们进行了调查 2，并进行了开放式访谈，重点关注对无效结果的反应。我们对回答进行了总体分析，并按基线腺瘤检出率 (ADR) 三等分进行了分析。我们使用主题分析和定性软件确定了关键主题。结果几乎所有结肠镜医生都做出了回应（调查 1 和 2 分别为 22 人和 24 人中的 21 人 [92% 和 88%]）。大多数人（96%）认为内窥镜检查能力对其职业身份至关重要。绝大多数人在试用 CADe 之前和之后都对人工智能表示信任和热情（82%-87%），并希望获得 CADe（72%）。近三分之二（62%）的人对无效结果感到惊讶。ADR 的差异很小。调查或个别访谈均未对无效结果做出统一解释。结论对人工智能/CADe缺乏热情或不信任并不能解释我们的实用 CADe 试验的无效结果。要实现人工智能在内窥镜检查中的应用前景，人工智能可能需要瞄准光学识别以外的领域。

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引用次数: 0

Novel point-of-care capsule to detect upper GI bleeding: initial real-world cases 用于检测上消化道出血的新型护理点胶囊：初步真实病例

iGIE

Pub Date : 2024-06-01 DOI: 10.1016/j.igie.2024.02.004

Daniel Szvarca MD , Trent Walradt MD , Amit Grover MD , Linda Lee MD

引用次数: 0

Intrathoracic cholecystitis managed with endoscopic gallbladder drainage 内镜胆囊引流术治疗胸腔内胆囊炎

iGIE

Pub Date : 2024-06-01 DOI: 10.1016/j.igie.2024.04.010

Andrea Huang MBBS, MPH , Thomas Williams MBBS , Nivene Saad MBBS , Adam Frankel MBBS , Zaki Hamarneh MD , Shwan Karim MBBS, MSc , Adrian Maher MD, MMed

引用次数: 0

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