Clinical Endoscopy最新文献

Background: Device-assisted enteroscopy has advanced small bowel disorder management. We conducted this meta-analysis to compare the clinical and procedural outcomes between spiral enteroscopy and single-balloon enteroscopy.

Methods: A systematic search was performed on December 1, 2024, in the PubMed, Scopus, and Cochrane Library databases to identify studies that compared spiral enteroscopy and single-balloon enteroscopy. The outcomes included diagnostic and therapeutic yields, total procedure time, depth of maximum insertion, and adverse event rates.

Results: Five studies (including 496 patients) met the inclusion criteria. The diagnostic yield was similar between spiral enteroscopy and single-balloon enteroscopy (risk ratio [RR], 1.07; 95% confidence interval [CI], 0.96-1.20; p=0.24). The therapeutic yield also showed no significant difference (RR, 1.10; 95% CI, 0.45-2.69; p=0.83). The total procedure time was comparable (mean difference, -22.85 minutes; 95% CI, -46.83 to 1.12; p=0.06), although motorized spiral enteroscopy reduced the procedure time (p<0.001). Spiral enteroscopy achieved greater depth of maximum insertion (standardized mean difference, 1.33; 95% CI, 0.65-2.01; p<0.001). Adverse event rates were comparable (RR, 1.72; 95% CI, 0.80-3.70; p=0.16).

Conclusions: Spiral and single-balloon enteroscopies demonstrated similar diagnostic and therapeutic yields and safety. Spiral enteroscopy achieved a greater insertion depth, and motorized systems improved the efficiency in terms of procedure times.

Background: Endoscopic resection of colorectal polyps reduces mortality from colorectal cancer. We report here a novel resection method, known as noninjecting resection using bipolar soft coagulation mode (NIRBS), and assess its feasibility. This study aimed to compare the resection depth achieved with NIRBS to those achieved with cold snare polypectomy (CSP) and conventional endoscopic mucosal resection (CEMR).

Methods: Patients with 6 to 9 mm colorectal polyps underwent endoscopic resection at Hoshigaoka Medical Center between October 2023 and January 2024. We analyzed the thickness of resected submucosal tissue following the use of NIRBS, CSP, and CEMR.

Results: We identified 95 polyps, including adenomas and serrated lesions. The proportions of specimens containing submucosal tissue were 21.4%, 100.0%, and 97.9% in CSP, CEMR, and NIRBS, respectively. The median submucosal tissue thickness for CEMR and NIRBS was 1,167 and 1,125 µm, respectively, which was significantly greater than 0 µm for CSP. For NIRBS, the median thickness was 1,140 and 1,017 µm for the expert and non-expert endoscopists, respectively.

Conclusions: The depth of submucosal resection with NIRBS exceeded 1,000 μm regardless of endoscopist experience. NIRBS can be a useful resection method for patients with colorectal polyps, including those with non-submucosally invasive carcinomas.

Background/aims: The International Society for Gastrointestinal Hereditary Tumors polyposis scoring system (IPSS) categorizes familial adenomatous polyposis (FAP) according to the burden of colorectal polyps and histology. However, the prognosis of patients with uncolectomized FAP has not been established.

Methods: Medical records of patients diagnosed with FAP between 1991 and 2021 were reviewed, and the IPSS stage was determined. The cumulative upstaging rate and risk factors for IPSS upstaging during surveillance were analyzed in patients without colectomies.

Results: Among 237 patients, 35 (28.9%) with IPSS stages 0-2 did not undergo colectomy. The cumulative risk of upstaging was 0%, 31%, 54%, and 73% at 1, 3, 7, and 10 years after FAP diagnosis, respectively. In univariate analysis, age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01-1.08; p=0.014) and having an ampulla of Vater adenoma (HR, 3.95; 95% CI, 1.17-13.30; p=0.027) were associated with upstaging. Multivariate analysis revealed that each 1-year increase in age was an independent risk factor of upstaging (adjusted HR, 1.04; 95% CI, 1.01-1.09; p=0.027).

Conclusions: In our analysis, patients with uncolectomized FAP and IPSS stages 0-2 at diagnosis showed a time-dependent progression in the IPSS stage.

The incidence of colorectal cancer (CRC) is increasing worldwide, which poses substantial social and economic challenges. To reduce CRC-related mortality, the implementation of screening programs is essential. The current standard approach involves initial screening using the fecal immunochemical test (FIT), followed by colonoscopy. However, the FIT has inherent limitations, including the potential to miss early stage CRC and insufficient detection rates from a single test. Therefore, the FIT is repeated annually or biennially, and the incidence of interval cancer remains a concern. In contrast, colonoscopy allows a highly accurate diagnosis of CRC in a single examination. Of the five randomized controlled trials evaluating the impact of colonoscopy on CRC mortality, two have reported results to date. The mortality reduction effect of colonoscopy-based screening was somewhat lower than expected in these studies, primarily because of low participation rates. Nonetheless, the fact that countries such as the United States and Germany, which have already implemented colonoscopy-based screening, have experienced substantial reductions in CRC mortality, which supports the expectations of the effectiveness of implementing such programs at the societal level. Among the challenges in their implementation, ensuring adequate participation rates is essential, and the establishment of an organized screening system is warranted.

Background/aims: Endoscopic ultrasound (EUS)-guided liver biopsy in patients with coagulopathy remains unexplored mainly because of the lack of effective hemostatic techniques in the event of post-biopsy bleeding. This study evaluated the feasibility and safety of a novel technique, EUS-guided plugged liver biopsy (EUS-PLB), which incorporates coil embolization for tract hemostasis.

Methods: In a pilot study, 20 patients with coagulopathy (platelets 20,000-50,000/μL or international normalized ratio 1.5-2.5) underwent EUS-PLB using a modified heparinized wet suction technique. Hemostasis was achieved via real-time EUS-guided deployment of 1 to 2 coils (35-5-3) into the needle tract. Outcomes included technical and clinical success, sample adequacy, and adverse events.

Results: Coil placement was technically successful in all patients. Persistent needle-tract bleeding occurred in five cases and was effectively controlled. The clinical success rate for preventing significant bleeding (early or delayed) was 100%. Adequate biopsy samples were obtained in 18/20 patients (90%), with a mean total specimen length of 3.34±0.88 cm and median complete portal tracts of 18 (range, 6-25). Histological diagnosis was possible in 95% of cases. One patient experienced a mild adverse event (5%).

Conclusions: This novel EUS-PLB technique with coil embolization may offer a safe and effective biopsy solution for patients with coagulopathy and warrants further investigation.

The Thai Association for Gastrointestinal Endoscopy (TAGE) has played a pivotal role in advancing gastrointestinal (GI) endoscopy in Thailand through its strategic focus on clinical services, education, and research. Since its establishment in 2005, TAGE has united gastroenterologists and surgeons, helping standardize endoscopic practices across the country. Through national training programs, clinical guideline development, hands-on workshops, and international collaborations, TAGE has elevated the quality and accessibility of endoscopic care. Despite challenges such as workforce shortages and the uneven distribution of services, particularly in rural areas, TAGE continues to address these gaps through outreach training, model development, and regional research initiatives. Society leadership in cholangiocarcinoma management, advanced endoscopy, and educational model innovation reflects its commitment to improving outcomes and establishing Thailand as a regional hub for GI endoscopy.

Optimal bowel preparation is critical for high-quality colonoscopy and the effective prevention of colorectal cancer. Although traditional high-volume polyethylene glycol (PEG) electrolyte lavage solutions are effective and safe, they are frequently limited by poor patient tolerability. To improve adherence, several low- and ultralow-volume PEG-based regimens, particularly 2 L and 1 L PEG plus ascorbate, have demonstrated noninferior efficacy and better patient compliance. Hyperosmotic alternatives, including oral sulfate solution and sodium picosulfate with magnesium citrate, provide comparable bowel-cleansing efficacy and are often favored for their improved palatability and tolerability. The recent introduction of oral sulfate tablets offers the convenience of a tablet form while maintaining efficacy similar to that of PEG-based regimens and significantly enhancing tolerability. However, a few cases of gastric mucosal irritation have been reported. Adjunctive simethicone also improves mucosal visibility by reducing intraluminal bubbles. With the growing diversity of bowel preparation options, regimen selection should be tailored to individual patient characteristics, including age, comorbidities, prior experiences, and personal preferences. A personalized evidence-based approach, guided by patient-specific factors and supported by emerging clinical data, can improve adherence, ensure adequate bowel cleansing, and enhance the diagnostic yield and procedural efficiency of colonoscopy.

Numerous clinical guidelines have been developed for the management of non-variceal upper gastrointestinal bleeding (NVUGIB), yet significant variations exist among the recommendations. This review summarizes the most recent evidence on NVUGIB management, structured across four key stages: pre-endoscopic management, endoscopic treatment, post-endoscopic care, and the identification and management of refractory bleeding. In the pre-endoscopic phase, several risk-scoring systems have been developed to predict mortality. A restrictive transfusion strategy, with a threshold of 7 to 8 g/dL, is now recommended for most patients. Pre-endoscopic administration of intravenous erythromycin also improves visualization during endoscopy. A wide array of endoscopic hemostasis techniques is available, with the choice of method depending on the underlying cause of bleeding. When endoscopic hemostasis fails, transcatheter arterial embolization (TAE) is generally preferred over surgery as the second-line intervention. Once hemostasis is achieved, high-dose acid suppression is essential, and the risk of rebleeding should be assessed. For patients who experience rebleeding, repeat endoscopic therapy is recommended as the first-line approach. However, determining the optimal timing for TAE remains a challenge. Because of the heterogeneity of clinical presentations, NVUGIB management should be personalized. Further research is needed to establish evidence-based, individualized treatment strategies.