iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.08.004

Karsten Büringer Dr med , Stefano Fusco Dr med , Dörte Wichmann PD Dr med , Ulrike Schempf Dr med , Pavlos Missios Dr rer med , Christoph Stein-Thöringer Prof Dr med , Dominik Zinsser Dr med , Nisar P. Malek Prof Dr med , Christoph R. Werner PD Dr med

引用次数: 0

Esophageal varices detection and bleeding risk assessment with artificial intelligence: a systematic review 人工智能检测食管静脉曲张及出血风险评估的系统综述

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.10.001

Rahul Ramakrishnan BS , Kevin Kuang BA , Vijay Rajput MD , Mark Benson MD , Sachin Mohan MD, PhD

Background and Aims

Esophageal varices (EVs) result from portal hypertension in decompensated liver disease secondary to liver cirrhosis. Diagnosis and grading is done using EGD and mucosal examination. However, interobserver differences may occur when analyzing EGD results. Recent application of artificial intelligence (AI) algorithms yielded mixed results for varices detection and bleeding risk estimation. The capabilities of AI in the detection and grading of EVs need to be evaluated.

Methods

A systematic review was conducted with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. PubMed, EMBASE, and MEDLINE were searched from January 1956 to July 2023. Data were manually identified and extracted by reviewers, assessing outcomes of AI tools used, EV detection accuracies, and bleeding risk prediction accuracies. Average accuracies were derived from result sections or manual calculations.

Results

Sixteen studies with 26,170 patients and 19 AI systems and algorithms were included after a review of 1670 studies. The most common AI systems were artificial neural network and random forest. The categorical boosting machine learning (ML) algorithm was most accurate for prediction of bleeding (100%), whereas the radiomic model ML tool was the least accurate for EV detection (49%). Overall, AI had an average EV detection accuracy of 78.67% and variceal bleed accuracy of 83.2%.

Conclusions

AI could provide an accessible interface for EV prediction and estimation of bleeding risk. Limitations include the dependence on a single dataset for efficacy, assessment with specific AI tools, and potential overinterpretation of broad geographic variances. Newer algorithms should have larger datasets with reproducible validity to strengthen the predictive value in clinical practice.

背景与目的食道静脉曲张（EVs）是肝硬化继发失代偿期肝病患者门静脉高压的结果。诊断和分级采用EGD和粘膜检查。然而，在分析EGD结果时，可能会出现观察者之间的差异。最近人工智能（AI）算法在静脉曲张检测和出血风险评估方面的应用结果好坏参半。人工智能在电动汽车检测和分级方面的能力有待评估。方法采用系统评价和meta分析指南的首选报告项目进行系统评价。检索了1956年1月至2023年7月的PubMed、EMBASE和MEDLINE。数据由审稿人手动识别和提取，评估使用的人工智能工具的结果、EV检测的准确性和出血风险预测的准确性。平均精度由结果分段或人工计算得出。结果在回顾了1670项研究后，纳入了16项研究，涉及26170名患者和19个人工智能系统和算法。最常见的人工智能系统是人工神经网络和随机森林。分类增强机器学习（ML）算法在预测出血方面最准确（100%），而放射学模型ML工具在EV检测方面最不准确（49%）。总体而言，AI平均EV检测准确率为78.67%，静脉曲张出血准确率为83.2%。结论ai可为EV预测和出血风险评估提供一个可访问的界面。局限性包括对单一数据集的有效性依赖，使用特定的人工智能工具进行评估，以及对广泛地理差异的潜在过度解释。新的算法应该有更大的数据集和可重复的有效性，以加强临床实践中的预测价值。

{"title":"Esophageal varices detection and bleeding risk assessment with artificial intelligence: a systematic review","authors":"Rahul Ramakrishnan BS , Kevin Kuang BA , Vijay Rajput MD , Mark Benson MD , Sachin Mohan MD, PhD","doi":"10.1016/j.igie.2024.10.001","DOIUrl":"10.1016/j.igie.2024.10.001","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Esophageal varices (EVs) result from portal hypertension in decompensated liver disease secondary to liver cirrhosis. Diagnosis and grading is done using EGD and mucosal examination. However, interobserver differences may occur when analyzing EGD results. Recent application of artificial intelligence (AI) algorithms yielded mixed results for varices detection and bleeding risk estimation. The capabilities of AI in the detection and grading of EVs need to be evaluated.</div></div><div><h3>Methods</h3><div>A systematic review was conducted with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. PubMed, EMBASE, and MEDLINE were searched from January 1956 to July 2023. Data were manually identified and extracted by reviewers, assessing outcomes of AI tools used, EV detection accuracies, and bleeding risk prediction accuracies. Average accuracies were derived from result sections or manual calculations.</div></div><div><h3>Results</h3><div>Sixteen studies with 26,170 patients and 19 AI systems and algorithms were included after a review of 1670 studies. The most common AI systems were artificial neural network and random forest. The categorical boosting machine learning (ML) algorithm was most accurate for prediction of bleeding (100%), whereas the radiomic model ML tool was the least accurate for EV detection (49%). Overall, AI had an average EV detection accuracy of 78.67% and variceal bleed accuracy of 83.2%.</div></div><div><h3>Conclusions</h3><div>AI could provide an accessible interface for EV prediction and estimation of bleeding risk. Limitations include the dependence on a single dataset for efficacy, assessment with specific AI tools, and potential overinterpretation of broad geographic variances. Newer algorithms should have larger datasets with reproducible validity to strengthen the predictive value in clinical practice.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 478-486"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140066","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

An unexpected finding after endoscopic management for dysplastic Barrett’s esophagus 内镜治疗巴雷特食管发育不良后的意外发现

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.09.006

Rajit Aziz Gilhotra MBBS (Hons), FRACP , Angad Walia BSc , Wei Xiong MD, FRCPC , Roberto Trasolini MD, FRCPC , Neal Shahidi MD, FRCPC, PhD

引用次数: 0

Preliminary validation of the virtual bariatric endoscopic simulator 虚拟减肥内窥镜模拟器的初步验证。

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.08.003

Utku Erden BSc , Mark A. Gromski MD , Suvranu De ScD , Doga Demirel PhD

Background and Aims

Obesity is a global health concern. Bariatric surgery offers reliably effective and durable weight loss and improvements of other comorbid conditions. However, the accessibility of bariatric surgery remains limited. Minimally invasive techniques, including endoscopic sleeve gastroplasty (ESG), have emerged to bridge this gap. To effectively complete the ESG procedure, one requires skill in multiple complex interventional endoscopic maneuvers. This requisite expertise poses challenges for training in this burgeoning field.

Methods

We designed the virtual bariatric endoscopic (ViBE) simulator software to mimic the ESG procedure accurately. The ViBE simulator features a detailed simulation of an endoscope equipped with an endoscopic suturing system and a high-resolution stomach, enhancing the visualization of procedural details. Furthermore, the simulator incorporates performance metrics using a reverse scoring system to evaluate users’ proficiency in tasks such as argon plasma coagulation (APC) marking, suturing, and cinching. To validate the simulator, we conducted a study involving experts and novices at the Indiana University School of Medicine, where participants engaged with the simulation environment in a series of training tasks.

Results

Twelve participants, comprising 5 experts and 7 novices, were asked to complete a post-training questionnaire featuring 7 items, rating each on a Likert scale. The APC task realism received the highest score, averaging 3.83. The usefulness of improving endoscopic technical skills averaged 3.08, with the realism of cinching the knot and suturing tasks receiving scores of 3.17 and 3.25, respectively, suggesting a generally positive reception. Automated performance metrics indicated that, on average, experts outperformed novices by 10.83 points.

Conclusions

The ViBE simulation strives to replicate the steps of the ESG within a virtual environment. Our primary objective in developing this simulator was to enhance the learning curve for endoscopic suturing and ESG techniques, thereby safely extending these skills to a broader patient base.

背景和目的：肥胖症是全球关注的健康问题。减肥手术能可靠、有效、持久地减轻体重，并改善其他并发症。然而，减肥手术的可及性仍然有限。包括内镜袖带胃成形术（ESG）在内的微创技术的出现弥补了这一差距。要有效完成 ESG 手术，需要熟练掌握多种复杂的介入性内窥镜操作。这些必要的专业知识给这一新兴领域的培训带来了挑战：方法：我们设计了虚拟减肥内窥镜（ViBE）模拟器软件，以准确模拟 ESG 手术。ViBE 模拟器详细模拟了配备内窥镜缝合系统和高分辨率胃的内窥镜，增强了手术细节的可视化。此外，该模拟器还采用了反向评分系统来评估用户在氩等离子凝固（APC）标记、缝合和夹紧等任务中的熟练程度。为了验证该模拟器，我们在印第安纳大学医学院进行了一项由专家和新手参与的研究，参与者在模拟环境中参与了一系列培训任务：由 5 名专家和 7 名新手组成的 12 名参与者被要求完成一份培训后调查问卷，其中包括 7 个项目，每个项目均采用李克特量表评分。APC任务真实性得分最高，平均为3.83分。提高内窥镜技术技能的实用性平均得分为 3.08 分，而收紧绳结和缝合任务的逼真性分别得分为 3.17 分和 3.25 分，这表明学员们普遍反映良好。自动性能指标显示，专家平均比新手高出 10.83 分：ViBE 模拟器致力于在虚拟环境中复制 ESG 的步骤。我们开发该模拟器的主要目的是提高内窥镜缝合和 ESG 技术的学习曲线，从而将这些技能安全地推广到更广泛的患者群体中。

{"title":"Preliminary validation of the virtual bariatric endoscopic simulator","authors":"Utku Erden BSc , Mark A. Gromski MD , Suvranu De ScD , Doga Demirel PhD","doi":"10.1016/j.igie.2024.08.003","DOIUrl":"10.1016/j.igie.2024.08.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Obesity is a global health concern. Bariatric surgery offers reliably effective and durable weight loss and improvements of other comorbid conditions. However, the accessibility of bariatric surgery remains limited. Minimally invasive techniques, including endoscopic sleeve gastroplasty (ESG), have emerged to bridge this gap. To effectively complete the ESG procedure, one requires skill in multiple complex interventional endoscopic maneuvers. This requisite expertise poses challenges for training in this burgeoning field.</div></div><div><h3>Methods</h3><div>We designed the virtual bariatric endoscopic (ViBE) simulator software to mimic the ESG procedure accurately. The ViBE simulator features a detailed simulation of an endoscope equipped with an endoscopic suturing system and a high-resolution stomach, enhancing the visualization of procedural details. Furthermore, the simulator incorporates performance metrics using a reverse scoring system to evaluate users’ proficiency in tasks such as argon plasma coagulation (APC) marking, suturing, and cinching. To validate the simulator, we conducted a study involving experts and novices at the Indiana University School of Medicine, where participants engaged with the simulation environment in a series of training tasks.</div></div><div><h3>Results</h3><div>Twelve participants, comprising 5 experts and 7 novices, were asked to complete a post-training questionnaire featuring 7 items, rating each on a Likert scale. The APC task realism received the highest score, averaging 3.83. The usefulness of improving endoscopic technical skills averaged 3.08, with the realism of cinching the knot and suturing tasks receiving scores of 3.17 and 3.25, respectively, suggesting a generally positive reception. Automated performance metrics indicated that, on average, experts outperformed novices by 10.83 points.</div></div><div><h3>Conclusions</h3><div>The ViBE simulation strives to replicate the steps of the ESG within a virtual environment. Our primary objective in developing this simulator was to enhance the learning curve for endoscopic suturing and ESG techniques, thereby safely extending these skills to a broader patient base.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 453-462"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973540","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

Clinical safety of a novel over-the-scope gastroduodenal full-thickness resection device for the treatment of upper GI tract lesions: a multicenter experience 一种新型超镜胃十二指肠全层切除装置治疗上消化道病变的临床安全性：多中心经验

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.09.004

Alyssa Y. Choi MD , Peter H. Nguyen MD , Jaehyun Kim MD , Julie Yang MD , Sherif A. Andrawes MD , Jean Chalhoub MD , Anastasia Chahine MD , Andrew Q. Giap MD , David P. Lee MD , Kenneth H. Park MD , Quin Y. Liu MD , Srinivas Gaddam MD , Kendrick Che DO , Michael Lajin MD , Wasseem Skef MD , Amirali Tavangar MD , John J. Kim MD , Jason B. Samarasena MD, MBA

Background and Aims

A novel gastroduodenal full-thickness resection device system was developed for resection of upper GI tract lesions. In this study, we evaluated the efficacy and safety of the gastroduodenal full-thickness resection device system.

Methods

Consecutive patients who received endoscopic resection of upper GI tract lesions from June 2020 to August 2022 using a gastroduodenal full-thickness resection device were evaluated from 8 U.S. centers. Primary endpoints were technical success and R0 resection. Secondary endpoints were en bloc resection, residual lesions at follow-up endoscopy, and immediate or delayed adverse events.

Results

Forty-four patients (mean age, 60.9 ± 15.8 years) received 45 resections for gastric (35, 80%) and duodenal (9, 20%) lesions. Thirty-four lesions (77%) were subepithelial and 10 (23%) were epithelial lesions. Technical success and en bloc resection were achieved in 43 (96%) and 41 (91%) patients, respectively. Furthermore, R0 resection was achieved in 32 patients (71%), including 24 of 35 (69%) with neoplastic lesions. Pathologic diagnosis included neuroendocrine tumor in 14 patients (32%), GI stromal tumor in 10 (23%), and gastric cancer or high-grade dysplasia in 7 (16%). Minor immediate and delayed bleeding occurred in 17 (38%) and 2 (4%) patients, respectively. One patient had delayed perforation, managed conservatively. On follow-up, 19 of 21 patients (90%) had no residual lesion.

Conclusions

In this multicenter series, the gastroduodenal full-thickness resection device demonstrated high rates of technical success and acceptable rate of R0 resection. Immediate minor bleeding was common, whereas serious adverse events were rare. This gastroduodenal full-thickness resection device should be considered in patients with gastroduodenal subepithelial lesions as an alternative to long-term surveillance.

背景与目的：研制一种新型胃十二指肠全层切除装置系统，用于上消化道病变的切除。在本研究中，我们评估了胃十二指肠全层切除装置系统的有效性和安全性。方法对2020年6月至2022年8月连续接受胃十二指肠全层切除术的上消化道病变患者进行评估，这些患者来自美国8个中心。主要终点为技术成功和R0切除。次要终点是整体切除、随访内镜检查时的残留病变和立即或延迟的不良事件。结果44例患者（平均年龄60.9±15.8岁）共行45例胃（35.80%）、十二指肠（9.20%）病变切除术。34例（77%）上皮下病变，10例（23%）上皮病变。技术成功和整体切除分别有43例（96%）和41例（91%）患者。此外，32例患者（71%）实现了R0切除术，其中35例患者中有24例（69%）存在肿瘤病变。病理诊断为神经内分泌肿瘤14例（32%），胃肠道间质瘤10例（23%），胃癌或高度不典型增生7例（16%）。分别有17例（38%）和2例（4%）患者发生轻微的即时和延迟出血。1例迟发性穿孔，保守处理。在随访中，21例患者中有19例（90%）无残留病变。结论在本多中心系列试验中，胃十二指肠全层切除装置技术成功率高，R0切除率可接受。立即轻微出血是常见的，而严重的不良事件是罕见的。对于胃十二指肠上皮下病变患者，应考虑采用这种胃十二指肠全层切除装置作为长期监测的替代方法。

{"title":"Clinical safety of a novel over-the-scope gastroduodenal full-thickness resection device for the treatment of upper GI tract lesions: a multicenter experience","authors":"Alyssa Y. Choi MD , Peter H. Nguyen MD , Jaehyun Kim MD , Julie Yang MD , Sherif A. Andrawes MD , Jean Chalhoub MD , Anastasia Chahine MD , Andrew Q. Giap MD , David P. Lee MD , Kenneth H. Park MD , Quin Y. Liu MD , Srinivas Gaddam MD , Kendrick Che DO , Michael Lajin MD , Wasseem Skef MD , Amirali Tavangar MD , John J. Kim MD , Jason B. Samarasena MD, MBA","doi":"10.1016/j.igie.2024.09.004","DOIUrl":"10.1016/j.igie.2024.09.004","url":null,"abstract":"<div><h3>Background and Aims</h3><div>A novel gastroduodenal full-thickness resection device system was developed for resection of upper GI tract lesions. In this study, we evaluated the efficacy and safety of the gastroduodenal full-thickness resection device system.</div></div><div><h3>Methods</h3><div>Consecutive patients who received endoscopic resection of upper GI tract lesions from June 2020 to August 2022 using a gastroduodenal full-thickness resection device were evaluated from 8 U.S. centers. Primary endpoints were technical success and R0 resection. Secondary endpoints were en bloc resection, residual lesions at follow-up endoscopy, and immediate or delayed adverse events.</div></div><div><h3>Results</h3><div>Forty-four patients (mean age, 60.9 ± 15.8 years) received 45 resections for gastric (35, 80%) and duodenal (9, 20%) lesions. Thirty-four lesions (77%) were subepithelial and 10 (23%) were epithelial lesions. Technical success and en bloc resection were achieved in 43 (96%) and 41 (91%) patients, respectively. Furthermore, R0 resection was achieved in 32 patients (71%), including 24 of 35 (69%) with neoplastic lesions. Pathologic diagnosis included neuroendocrine tumor in 14 patients (32%), GI stromal tumor in 10 (23%), and gastric cancer or high-grade dysplasia in 7 (16%). Minor immediate and delayed bleeding occurred in 17 (38%) and 2 (4%) patients, respectively. One patient had delayed perforation, managed conservatively. On follow-up, 19 of 21 patients (90%) had no residual lesion.</div></div><div><h3>Conclusions</h3><div>In this multicenter series, the gastroduodenal full-thickness resection device demonstrated high rates of technical success and acceptable rate of R0 resection. Immediate minor bleeding was common, whereas serious adverse events were rare. This gastroduodenal full-thickness resection device should be considered in patients with gastroduodenal subepithelial lesions as an alternative to long-term surveillance.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 490-500"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139959","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

Novel hemostatic adhesive powder to prevent delayed bleeding after endoscopic submucosal dissection in the GI tract: first U.S. multicenter experience 新型止血胶粘剂预防内镜下胃肠道粘膜下剥离后迟发性出血：美国首次多中心经验

iGIE

Pub Date : 2024-12-01 DOI: 10.1016/j.igie.2024.10.002

Dennis Yang MD , Amit Bhatt MD , Maham Hayat MD , Muhammad K. Hasan MD , Hiroyuki Aihara MD, PhD

Background and Aims

Delayed bleeding (DB) is a common adverse event after endoscopic submucosal dissection (ESD). We evaluated a novel hemostatic powder (UI-EWD, Nexpowder; Medtronic, Minneapolis, Minn, USA) to prevent DB after ESD.

Methods

This was a multicenter retrospective analysis of ESDs performed between January 2023 and March 2024 in which UI-EWD was applied to prevent DB. Cases in which endoscopic closure of the post-ESD mucosal defect was performed were excluded. DB was defined as a bleeding event requiring hospitalization, blood transfusion, or any intervention within 30 days after the procedure. Technical success of UI-EWD was defined as successful delivery and application of the hemostatic powder over the entire mucosal defect.

Results

Eighty-three patients (median age, 66 years) underwent ESD in the esophagus (n = 18), stomach (n = 15), colon (n = 38), and rectum (n = 12). The median lesion size was 50 mm (interquartile range, 41-70 mm). UI-EWD was successfully applied in all defects, although in 2 cases (2.4%) a second delivery catheter had to be used to complete the procedure. DB occurred in 3 patients (3.6%): 2 after gastric ESD and 1 after colonic ESD within 24 hours of the index procedure. None required intervention on repeat endoscopy. There were no cases of perforation. En bloc and R0 resection rates were 96.2% and 88.7%, respectively.

Conclusions

UI-EWD can be easily applied to mucosal defects after ESD throughout the GI tract. Initial data from this multicenter study demonstrate that the use of UI-EWD was associated with a relatively low rate of DB after ESD. Additional comparative studies are needed to corroborate these preliminary findings.

背景与目的迟发性出血（DB）是内镜下粘膜下剥离（ESD）术后常见的不良事件。我们评估了一种新型止血粉(UI-EWD, Nexpowder；Medtronic, Minneapolis, minnesota USA)预防ESD后的DB。方法：对2023年1月至2024年3月期间应用UI-EWD预防DB的ESDs进行多中心回顾性分析。排除了内镜下封闭esd后粘膜缺损的病例。DB定义为手术后30天内需要住院、输血或任何干预的出血事件。UI-EWD的技术成功定义为止血粉在整个粘膜缺损上的成功输送和应用。结果83例患者（中位年龄66岁）分别在食管（18例）、胃（15例）、结肠（38例）和直肠（12例）行ESD。中位病灶大小为50 mm（四分位数范围为41-70 mm）。UI-EWD在所有缺陷中都成功应用，尽管在2例（2.4%）中必须使用第二根导尿管来完成该过程。3例（3.6%）发生DB: 2例发生在胃ESD后，1例发生在结肠ESD后。重复内镜检查不需要干预。无穿孔病例。整体和R0切除率分别为96.2%和88.7%。结论sui - ewd可方便地应用于全消化道ESD后的粘膜缺损。这项多中心研究的初步数据表明，使用UI-EWD与ESD后相对较低的DB率相关。需要更多的比较研究来证实这些初步发现。

{"title":"Novel hemostatic adhesive powder to prevent delayed bleeding after endoscopic submucosal dissection in the GI tract: first U.S. multicenter experience","authors":"Dennis Yang MD , Amit Bhatt MD , Maham Hayat MD , Muhammad K. Hasan MD , Hiroyuki Aihara MD, PhD","doi":"10.1016/j.igie.2024.10.002","DOIUrl":"10.1016/j.igie.2024.10.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Delayed bleeding (DB) is a common adverse event after endoscopic submucosal dissection (ESD). We evaluated a novel hemostatic powder (UI-EWD, Nexpowder; Medtronic, Minneapolis, Minn, USA) to prevent DB after ESD.</div></div><div><h3>Methods</h3><div>This was a multicenter retrospective analysis of ESDs performed between January 2023 and March 2024 in which UI-EWD was applied to prevent DB. Cases in which endoscopic closure of the post-ESD mucosal defect was performed were excluded. DB was defined as a bleeding event requiring hospitalization, blood transfusion, or any intervention within 30 days after the procedure. Technical success of UI-EWD was defined as successful delivery and application of the hemostatic powder over the entire mucosal defect.</div></div><div><h3>Results</h3><div>Eighty-three patients (median age, 66 years) underwent ESD in the esophagus (n = 18), stomach (n = 15), colon (n = 38), and rectum (n = 12). The median lesion size was 50 mm (interquartile range, 41-70 mm). UI-EWD was successfully applied in all defects, although in 2 cases (2.4%) a second delivery catheter had to be used to complete the procedure. DB occurred in 3 patients (3.6%): 2 after gastric ESD and 1 after colonic ESD within 24 hours of the index procedure. None required intervention on repeat endoscopy. There were no cases of perforation. En bloc and R0 resection rates were 96.2% and 88.7%, respectively.</div></div><div><h3>Conclusions</h3><div>UI-EWD can be easily applied to mucosal defects after ESD throughout the GI tract. Initial data from this multicenter study demonstrate that the use of UI-EWD was associated with a relatively low rate of DB after ESD. Additional comparative studies are needed to corroborate these preliminary findings.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 501-506"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139960","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

Expert commentary: unveiling a rare adverse event 专家评论：揭开罕见不良事件的面纱

iGIE

Pub Date : 2024-09-01 DOI: 10.1016/j.igie.2024.06.007

Diogo Turiani Hourneaux de Moura MD, MSc, PhD, Post-PhD , Daniel Szvarca MD

引用次数: 0

Gastric peroral endoscopic myo-neurotomy as less-invasive bariatric surgery in porcine models: an experimental study 胃口周围内窥镜肌神经切断术作为猪模型的微创减肥手术：一项实验研究

iGIE

Pub Date : 2024-09-01 DOI: 10.1016/j.igie.2024.06.002

Kenta Hamada MD, PhD , Yasushi Yamasaki MD, PhD , Akinobu Takaki MD, PhD , Takehiro Tanaka MD, PhD , Hiroyuki Okada MD, PhD

Background and Aims

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.

背景和目的肥胖是一个全球性的健康问题，需要采用微创治疗方法。方法将六头活猪分为三组，每组两头：高脂饮食（HFD）下的 POEM-N 组（POEM-N 组）；高脂饮食下的假手术组（HF-对照组）；正常饮食下的假手术组（N-对照组）。所有猪只均喂食上述饮食 2 周，接受 POEM-N 或假手术，并在手术后观察 2 周。主要结果是POEM-N的安全性和可行性。评估POEM-N术后的不良反应和组织学，以评估手术的安全性和可行性。次要结果是体重和糖脂水平的变化。结果在 POEM-N 过程中或之后，生命体征没有严重恶化。所有猪只都很健康，采食量良好，没有延迟不良事件。如预期的那样，POEM-N 术后观察到食物残渣过度储存、胃窦变形和折叠浓缩。组织学检查显示，两头 POEM-N 猪的奥尔巴赫丛肥厚再生，而奥尔巴赫丛是胃蠕动的调节器。结论我们应用 POEM-N 作为减肥/代谢手术，并通过猪模型证明了其安全性和可行性。

{"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}

引用次数: 0

Evaluation of the safety and feasibility of outpatient colorectal endoscopic submucosal dissection 评估门诊大肠内镜黏膜下剥离术的安全性和可行性

iGIE

Pub Date : 2024-09-01 DOI: 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.

背景和目的内镜黏膜下剥离术（ESD）越来越多地用于切除良性非截石性大肠息肉和早期癌症。然而，人们担心ESD的采用可能会受到术后常规入院所增加的资源利用率的限制。随着ESD伤口的内镜闭合技术不断改进，2022年，我们采用了门诊结直肠ESD方案。方法本研究是对2022年1月至2023年4月期间接受结直肠ESD的成年患者进行的回顾性评估。在技术可行的情况下，用夹子或缝合器缝合伤口。术后，我们对患者进行了长达 2 小时的观察，如果患者无腹痛且术中无肌肉损伤，即可出院。我们对手术成功率（全切、R0、根治性切除）和安全性（术后疼痛、穿孔、延迟出血）进行了评估。19个病灶（17%）曾接受过EMR。所有病灶均成功切除：全切率为 93%，R0 和根治性切除率为 90%。99处伤口（89%）被缝合，最常见的是使用夹子（60/111；54%）。发生了两例小的术中穿孔，均用夹子缝合，患者无需入院。在进行缺损闭合的患者中，没有需要住院治疗的延迟性出血，只有一次自限性出血。与此相反，在 12 名切除部位不适合闭合的患者中，有 1 例延迟出血需要住院治疗，2 例轻微出血在急诊科进行了评估，2 例为自限性出血。在 105 名患者中，只有 2 人需要入院治疗：1 人因术后疼痛入院，1 人因延迟出血入院。我们发现，在内窥镜下闭合ESD伤口后，一般不需要入院治疗，术后大出血的情况也很少见。

{"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}

引用次数: 0

Boldly going where no one has gone before: a history of peroral endoscopic myotomy in the United States 勇往直前：美国口腔内窥镜肌切开术的发展史

iGIE

Pub Date : 2024-09-01 DOI: 10.1016/j.igie.2024.07.007

Stavros N. Stavropoulos MD, FASGE , Phillip S. Ge MD, FASGE

引用次数: 0