Clinical Endoscopy最新文献

Since 2001, capsule endoscopy has been the primary test used to diagnose small-intestinal diseases. However, video capsule endoscopy of the stomach was considered impractical because visualizing the entire stomach was deemed impossible and would require a steerable capsule. Magnetically controlled gastric capsule endoscopy has been increasingly used for the diagnosis of gastric diseases, with significant developments in China. This noninvasive, hygienic, and comfortable method has gained popularity as an alternative to traditional electronic gastroscopy owing to its disposable nature and recent hardware upgrades (resolution, brightness, and field of view). Important steps forward with artificial intelligence and robots allow for the automated detection and characterization of gastric lesions. As it was restricted in China, questions have been raised about its cost-effectiveness worldwide, particularly in countries where early gastric cancer is not a priority. In this paper, I review the initial trials with this innovative capsule and the important technical updates in the last 5 years: robots for capsule guidance and artificial intelligence for the detection and characterization of gastric lesions.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is conventionally performed in the prone position (PP). Recent studies have shown that the supine position (SP) is an effective alternative, with comparable success rates. We conducted a meta-analysis to directly compare the safety and efficacy of the two ERCP positions.

Methods: In line with Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review was performed through a comprehensive search of PubMed, Embase, Web of Science, and the Cochrane Library. Statistical analyses were performed using RevMan, with results considered significant at p<0.05 and reported as odds ratios (ORs) and mean differences (MDs).

Results: Eleven studies (24,285 patients) were included in the final analysis. Procedural success was significantly higher in the PP (OR, 0.52; 95% confidence interval [CI], 0.36-0.75; p<0.0004) than the SP. However, no significant difference was observed in procedure times (MD, 0.22; 95% CI, -7.07 to 7.50; p=0.95), number of cardiopulmonary complications (OR, 1.08; 95% CI, 0.47-2.48; p=0.86), or post-ERCP pancreatitis (OR, 1.12; 95% CI, 0.52-2.42; p=0.31) between the two groups.

Conclusions: The PP demonstrates superior ERCP success compared to the SP, without prolonging procedure time or increasing the risk of adverse events. However, given the comparable procedure times, incidence of adverse events, and increased comfort for both patients and anesthesiologists, the SP may be a suitable alternative for a select group of patients in whom the PP is not feasible, such as those with morbid obesity or recent abdominal surgery.

Background: Hepaticojejunostomy strictures (HJSS), recurrent cholangitis, and jaundice are major complications of surgical hepaticojejunostomy. Previously, HJSS was managed using percutaneous procedures and balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography. However, endoscopic ultrasound-biliary drainage (EUS-BD) was recently reported to be an effective salvage procedure. EUS-BD as a primary drainage method using a trans-endosonographically created route (trans-ESCR) has not been previously evaluated.

Methods: We enrolled consecutive patients who underwent EUS-BD for HJSS at the Juntendo University Hospital between March 2017 and December 2022. After ESCR maturation, multiple plastic stents were placed for 1 year with or without cholangioscopic evaluation. We evaluated the technical and clinical success rates, stent removal, HJSS recurrence, and related adverse events.

Results: Thirty-seven patients required EUS-guided hepaticogastrostomy/hepaticojejunostomy (n=36/1). The technical and clinical success rates were 94.6% and 100.0%, respectively, and 17% of patients experienced adverse events. Cholangioscopy via ESCR was performed in 19 patients to evaluate the strictures and manage concomitant stones. The success rate of stent removal after multiple stent placements for more than 1 year was 83%.

Conclusions: Primary EUS-BD and trans-ESCR are feasible and effective in the management of HJSS. Further prospective studies are needed to confirm the results of this pilot study.

Background: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an effective diagnostic technique; however, few studies have evaluated the efficacy of trans-colorectal EUS-FNA. This study assessed the feasibility of trans-colorectal EUS-FNA.

Methods: We retrospectively analyzed 76 consecutive patients who underwent trans-colorectal EUS-FNA for pelvic lesions between January 2013 and September 2023.

Results: A total of 76 pelvic lesions were identified. The median number of EUS-FNA punctures was 3 (1-8). The median lesion size was 18.9 (8.2-100.0) mm. The success rate was 98.7% (75/76), with no reported adverse events. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA were 94.3% (50/53), 100% (22/22), 100% (50/50), 88.0% (22/25), and 96.0% (72/75), respectively. Malignancy was initially suspected in 65 patients before EUS-FNA; however, 25 patients showed benign results. Of these, three were later reexamined and diagnosed with malignancy, three underwent surgery and were found to have benign pathology, and 19 avoided unnecessary surgery.

Conclusions: Trans-colorectal EUS-FNA is a safe and effective diagnostic procedure.

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.