Clinical Endoscopy最新文献

Background/aims: Obesity is an increasing health concern worldwide, and an elevated body mass index (BMI) may influence the outcomes of endoscopic retrograde cholangiopancreatography (ERCP). This systematic review and network meta-analysis aimed to investigate the association between BMI and ERCP outcomes.

Methods: A systematic search was performed using PubMed, Scopus, and Web of Science to identify relevant studies that reported clinical outcomes of ERCP in different BMI groups. Patients were categorized into five BMI-based following groups: underweight (BMI<18.5 kg/m²), normal weight (18.5 kg/m²≤BMI<25 kg/m²), overweight (25 kg/m²≤BMI<30 kg/m²), obesity (30 kg/m²≤BMI<40 kg/m²), and morbid obesity (40 kg/m²≤BMI).

Results: Among 3,001 unique citations, seven were included in the study. Meta-analysis revealed that obesity was not associated with an increased risk of post-ERCP pancreatitis (PEP) (odds ratio, 1.33; 95% confidence interval, 0.62-2.87). In the network analysis, none of the five BMI groups had a significantly higher risk of PEP than that of the other groups (p>0.05). Moreover, the BMI groups had similar rates of difficult cannulation, successful cannulation, complete stone extraction, and procedural success.

Conclusions: ERCP success and adverse events were similar among different BMI groups. Neither an elevated nor a low BMI was associated with an increased risk of PEP. Further large-scale prospective studies are required to validate these findings.

Background/aims: The treatment of cystic duct confluence stones often requires peroral cholangioscopy (POCS)-guided lithotripsy. This study evaluated the efficacy of endoscopic treatment for cystic duct confluence stones and identified predictive factors for the need for POCS-guided lithotripsy.

Methods: This retrospective cohort study included 38 patients with cystic duct confluence stones treated endoscopically between September 2007 and December 2023. The primary outcome was the rate of complete stone removal. Secondary outcomes included the number of sessions, total procedure time, adverse events, and predictive factors for POCS-guided lithotripsy.

Results: The complete stone removal rate was 100%. POCS-guided lithotripsy was required in 50% of the cases. The mean number of sessions needed for stone removal was 2.05. The mean procedure time was 93.9 minutes. The incidence of adverse events was 13%. Multivariate analysis showed that a minor axis length of the stone relative to the distal bile duct diameter greater than 1.2 was an independent predictive factor for requiring POCS-guided lithotripsy.

Conclusions: Endoscopic treatment is highly effective for cystic duct confluence stones. However, POCS-guided lithotripsy was necessary when the minor axis of the stone relative to the distal bile duct diameter exceeded 1.2.

Background/aims: Gastric subepithelial tumors (SETs) located near the esophagogastric junction (EGJ) are difficult to treat surgically and endoscopically. This study aimed to evaluate the effectiveness and safety of endoscopic resection of SETs growing from the muscularis propria located in the EGJ and gastric cardia.

Methods: This study included 26 consecutive patients who underwent endoscopic resection of 27 gastric SETs between November 2012 and May 2023.

Results: Of the 27 gastric SETs, 3 and 24 were located in the EGJ and gastric cardia, respectively. The mean tumor size, operative time, and duration of hospitalization were 21 (6-52) mm, 35.4 (9-65) minutes, and 4.2 (3-7) days, respectively. Endoscopic resection of the SETs achieved an en bloc resection rate of 100% (27/27) and a complete resection rate of 88.9% (24/27). Pathological examination confirmed four gastrointestinal stromal tumors and 23 leiomyomas. No bleeding, peritonitis, or abdominal infection occurred after the endoscopic resections. Residual lesions were identified in three patients (11.1%). No recurrence was observed during follow-up (range, 3-24 months).

Conclusions: SETs in the EGJ and gastric cardia can be resected effectively, even if they originate from the muscularis propria layer.

Endoscopic ultrasound (EUS)-guided elastography is an advanced imaging technique designed to improve assessment of lesion characteristics and disease diagnosis. It allows real-time assessment of tissue stiffness and is currently available in the form of strain elastography (SE) and shear wave elastography (SWE). While EUS-guided SE has high sensitivity for diagnosing malignant solid pancreatic lesions, its specificity remains modest. SWE is a novel technology currently available on the EUS platform. Promising data have been reported on the utility of EUS-guided SWE in various diseases of the pancreas and liver. This review aims to discuss the applications of EUS-guided SE and SWE in pancreatic and liver diseases.