Clinical Endoscopy最新文献

Background/aims: Biliary cannulation is a critical component of endoscopic retrograde cholangiopancreatography (ERCP). When standard methods fail, needle-knife precut sphincterotomy (NKPS) is commonly employed. This systematic review and meta-analysis evaluated the safety and efficacy of using NKPS as a primary technique.

Methods: Electronic databases were searched for studies published between January 2000 and November 2024 that assessed outcomes of primary precut techniques. "Primary precut" was defined as needle-knife sphincterotomy performed as the initial approach without any prior standard cannulation attempts. Pooled proportions were calculated using random-effects models, and heterogeneity was assessed using the Q-test and the I² statistic.

Results: The mean patient age was 57.95 years (standard deviation [SD], 7.59), and 53.23% were female. The cannulation success rate was 96.50% (95% confidence interval [CI], 94.90-97.60) with no heterogeneity (Q, 7.10; df, 8; I²=0%; p=0.935). The rates of adverse events were as follows: post-ERCP pancreatitis, 1.90% (95% CI, 1.20-3.10; I²=0; p =0.942); bleeding, 2.60% (95% CI, 1.70-4.00, I²=0; p=0.725); cholangitis, 1.50% (95% CI, 0.60-3.60; I²=45.27; p=0.067); and perforation, 0.90% (95% CI, 0.40-1.90; I²=0; p=0.948). The overall adverse event rate was 9.70% (95% CI, 5.70-16.10; I²=83.39; p<0.001).

Conclusions: Primary precut sphincterotomy appears to be an effective and safe technique for biliary cannulation in ERCP. These findings support its consideration as a viable first-line approach in appropriate clinical settings.

Background/aims: 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.

Colorectal cancer (CRC) remains a major global health concern, showing significant variation in incidence and trends across different populations and age groups. While overall rates in older adults have declined in many high-income countries due to effective screening, the incidence of early-onset CRC, diagnosed before age 50, has been rising worldwide, especially in East Asia. Both early- and late-onset CRC share many risk factors, broadly categorized as modifiable and non-modifiable. Non-modifiable factors include age, sex, family history, hereditary syndromes, and inflammatory bowel disease. Modifiable factors such as obesity, unhealthy diet, physical inactivity, smoking, and alcohol consumption play a substantial role in CRC development and offer important targets for prevention. Lifestyle modifications-including weight control, regular physical activity, smoking cessation, and a balanced diet rich in fiber and vegetables-are associated with reduced CRC risk. In selected individuals, chemoprevention with low-dose aspirin may also lower CRC incidence. Screening and early detection remain essential strategies to reduce the CRC incidence and mortality, while comprehensive prevention efforts are needed to address the growing burden of CRC across diverse populations.

Video capsule endoscopy (VCE) originally revolutionized gastrointestinal imaging by providing a noninvasive method for evaluating small bowel diseases. Recent technological innovations, including enhanced imaging systems, artificial intelligence (AI), and improved localization, have significantly improved VCE's diagnostic accuracy, efficiency, and clinical utility. This review aims to summarize and evaluate recent technological advances in VCE, focusing on system comparisons, image enhancement, localization technologies, and AI-assisted lesion detection.

Endoscopic full-thickness resection has become more and more popular. One of the most important parts of this procedure is the closure of these full-thickness defects. Apart from conventional through-the-scope (TTS) clips, several different methods and devices have emerged as safe and efficacious in recent years. New clips include the anchor pronged TTS clips, dual-action tissue clips, and over-the-scope-clips. There are also new line or loop-assisted closure methods such as clip loop method, reopenable clip over line method, loop 9 method, and the internal-traction-assisted suspended closure method. New devices include the helical tacking system and endoscopic suturing device. This review article will discuss in details the usage of these different methods and available literature on comparison between the different closure methods.

Inflammatory bowel disease is classified into Crohn's disease (CD) and ulcerative colitis. Ulcerative colitis involves only the colon, whereas CD is characterized by small bowel involvement, which is a hallmark feature. However, the small bowel is the final frontier of endoscopic evaluation; therefore, small bowel involvement is considered a significant medical challenge in the diagnosis and treatment of patients with CD. Endoscopic visualization and biopsy sampling of the small bowel are crucial for accurate diagnosis, effective monitoring, and management of complications of CD. Small bowel endoscopy enables the early detection of mucosal lesions, facilitates timely intervention for complications such as strictures or bleeding, and plays a critical role in reducing the need for surgical resection. Moreover, it enables targeted tissue acquisition and objective assessment of disease activity, both of which are crucial for optimal treatment planning and monitoring of therapeutic responses. Given these clinical advantages, small bowel endoscopy has become an indispensable tool in the comprehensive management of CD. This review summarizes the current role and evolving advances in small bowel endoscopy, with particular emphasis on its therapeutic applications-including enteroscopic balloon dilation, endoscopic hemostasis, and foreign body retrieval-and discusses future directions based on recent evidence and expert guidelines.