Current Gastroenterology Reports最新文献

Purpose of review: Virtual reality (VR) and augmented reality (AR) are emerging technologies with significant potential in medical education and therapeutic interventions, particularly within gastroenterology. This review aims to explore the current applications of VR and AR in enhancing endoscopy training, procedural skills, and patient comfort, while also identifying their role in non-pharmacological pain management and pre-procedure education.

Recent findings: Extensive research has been conducted on the use of VR and AR in surgical and neurological fields, but their application in gastroenterology is still evolving. VR simulators provide realistic training environments, contributing to improved procedural skills and patient care. Additionally, VR has been shown to reduce patient discomfort and serve as an alternative to sedation during procedures like colonoscopies. AR, specifically in colonoscopies, has demonstrated potential in enhancing polyp detection by overlaying real-time digital information, leading to better diagnostic accuracy. Studies also suggest that VR can improve patient outcomes in functional gastrointestinal disorders and enhance pre-procedure education, increasing patient satisfaction. VR and AR hold significant promise in gastroenterology by advancing both educational and procedural practices. These technologies offer cost-effective, patient-friendly solutions that improve diagnostic accuracy and patient outcomes. Continued research is essential to fully realize the benefits of VR and AR in gastroenterology, as these tools become more prevalent in clinical practice.

Purpose of review: Common indications to evaluate exocrine pancreatic function in children include chronic diarrhea, steatorrhea, failure to thrive, cystic fibrosis and those with chronic abdominal pain due to chronic pancreatitis where imaging studies are normal [1]. Exocrine Pancreatic Insufficiency (EPI) has a spectrum of severity. In children often remains an underdiagnosed condition, particularly in its mild, partial, and isolated enzyme deficiency forms. The purpose of this review is to help understand the different varieties of EPI including isolated pancreatic enzyme deficiencies as possible causes of malnutrition and growth failure in pediatric patients.

Recent findings: Among the indirect diagnostic methods, the fecal elastase-1 (FE-1) testing is the most widely used one. While it has good sensitivity and specificity in severe pancreatic damage, like cystic fibrosis in children, its performance in the diagnosis of mild, partial, and isolated enzyme deficiencies is poor. Direct pancreatic function testing performed during endoscopy (ePFT), has emerged as a more sensitive and specific method for assessing all forms of exocrine pancreatic function. Notably, recent guidelines from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) emphasize the importance of ePFT in pediatric patients.  Most of the pediatric practitioners taught that the pancreas has only two diseases, cystic fibrosis and pancreatitis. They are missing the fact that pancreas, like other digestive organs, can have different, many times secondary, dysfunctions that influence the growth of children. Most pediatric gastroenterologists still use the fecal elastase-1 (FE-1) test, however, this lacks sufficient specificity and sensitivity [2-5] especially in patients with mild or early pancreatic disease or those with isolated enzyme deficiencies [5]. The most accurate diagnostic modality to explore these conditions is ePFT. In this review we highlighted the critical importance of direct pancreatic function testing. Enhancing clinical awareness and incorporating direct testing methods can ultimately improve outcomes for affected children.

Purpose of review: Since the introduction of ERCP and EUS in the 1980s, the field of advanced endoscopy has witnessed significant growth, necessitating formalized fellowship training to ensure competency and patient safety. This article reviews the history and development of Advanced Endoscopy Fellowship (AEF) training in North America, outlining current challenges such as variability in training standards, case volume, and faculty expertise.

Recent findings: General gastroenterology fellowships with apprenticeship model training in advanced endoscopic procedures have been insufficient, prompting the establishment of Advanced Endoscopy Fellowship (AEF) programs across North America. There are emerging trends in interventional endoscopy training, such as competency-based education (CBE), simulation-based training (SBT), and video-based training (VBT). There are new pathways for specialized modular and robotic training and non-traditional routes for EUS and ERCP skill acquisition. Variability across AEF programs remains concerning. This highlights the need for expanded regulatory efforts by organizations like ASGE. Advanced endoscopy training continues to evolve with innovative educational models. However, addressing variability, resource constraints, and employment challenges will be essential to meet the expanding procedural demands of this field and improve patient outcomes.

Purpose of review: Subepithelial lesions (SELs) are tumors originating from the gastrointestinal (GI) tract wall (muscularis mucosa, submucosa, or muscularis propria) and are covered by overlying mucosa. They are typically incidental findings during routine endoscopy. This article reviews the latest advancements in endoscopic techniques and devices used to resect subepithelial lesions.

Recent findings: Endoscopic Ultrasound (EUS) should be employed to characterize SELs, with fine needle core biopsy (FNB) utilized with EUS for histopathologic tissue acquisition. EUS can be used as "endoscopic mapping" to mitigate serious complications prior to endoscopic resection. Techniques such as Submucosal Tunnelling Endoscopic Resection (STER), Device-Assisted Endoscopic Full Thickness Resection, and Freehand Full Thickness Resection are available for the complete resection of SELs. The choice of technique depends on the characteristics of the lesion and the level of expertise of the endoscopist. Multiple endoscopic resection techniques for SELs have been developed, each utilizing different tools and devices. A significant shift has occurred from traditional laparoscopic surgical resection to minimally invasive, organ-sparing endoscopic resection. Advancements in "third space" endoscopy and the innovation of novel devices continue to offer less invasive resection techniques for lesions arising from the GI tract wall.

Purpose of review: Inflammatory bowel disease (IBD) can cause significant psychological, physical, and economic burdens on patients and healthcare systems. Studies show over one-fifth of patients will seek nontraditional methods of treatment for managing their symptoms. Understanding the benefits - and potential harms - of these therapies is important to provide holistic and evidence-based care to our IBD patients.

Recent findings: In this review, we present several studied herbal therapies for the management of both Crohn's disease and ulcerative colitis. These include cannabinoids, Tripterygium wilfordii, Chios mastic gum, Boswellia serrata, Indigo Naturalis, curcumin, resveratrol, and Zingiber officinale. While these herbal remedies have been shown to have anti-inflammatory effects and positive outcomes in IBD patients, larger scale studies are lacking and the use may be limited by bioavailability, lack of standardization of formulations, and adverse reactions. In reviewing the literature, we discuss the current data available including benefits, adverse reactions, and considerations for use surrounding several of the more common herbal remedies used for IBD.

Purpose: To propose a gastrointestinal bleeding management algorithm that incorporates an endoscopic and imaging scoring system and specifies management of vascular complication from button battery ingestion.

Recent findings: Button batteries (BB) are found in many electronic devices and ingestions are associated with serious complications especially in cases of unwitnessed ingestions, prolonged impaction, and in children less than 5 years of age. Gastrointestinal bleeding from BB related vascular injury is rare but often rapidly fatal, with a mortality rate as high as 81%. There are no evidence-based guidelines for managing vascular complications from button battery ingestions. This paper proposes a management algorithm that 1) incorporates both an endoscopic and imaging scoring system to guide initial, post procedure, and discharge care and 2) specifies management of button battery related vascular bleeding. The endoscopic score is a modified Zargar classification with added categories for suspected aneurysm and tracheoesophageal fistula. Surgical and endovascular interventions for vascular injury are also reviewed. Until evidence-based guidelines can be developed, hospitals should have a multidisciplinary protocol based on institutional expertise to rapidly manage BB related vascular injury. Prevention of BB related injury offers the best hope of preventing serious complications and should include increasing public awareness and improving safety standards by working with industry and government.

Purpose of review: The prevalence of IBD in older adults is rapidly growing. Older adults with IBD are underrepresented in research and clinical trials and yet at great risk for adverse events. Therefore, understanding advanced aged associated constructs in older adults can be critical to improving the management of older adults with IBD.

Recent findings: In this review, we present recent studies on frailty in IBD. We identify 4 major themes in the literature: studies that describe frailty in patients with IBD, studies that report on consequences of frailty, studies of frailty as a risk stratification modality, and studies of frailty as an exposure and outcome. In reviewing the literature, we discuss the heterogeneity that exists and outline future directions to ensure appropriate applications for frailty in the field of IBD.

Purpose of review: This review explores the pharmacokinetics, benefits, and risks of proton pump inhibitors (PPIs) in cirrhotic patients, focusing on the appropriateness of their use and potential adverse effects.

Recent findings: Recent studies highlight significant pharmacokinetic alterations in PPIs among cirrhotic patients, with marked increases in lansoprazole and pantoprazole exposure and relatively stable levels of esomeprazole. While effective for managing acid-related disorders and post-band ulcer rebleeding, evidence supporting PPI use for portal hypertension-related bleeding is lacking. Emerging research suggests potential adverse effects such as hepatic decompensation, spontaneous bacterial peritonitis, hepatic encephalopathy, and increased mortality, possibly linked to dysbiosis and bacterial translocation. PPI use in cirrhotic patients alters pharmacokinetics significantly, with esomeprazole potentially safer in advanced cirrhosis. The review advises caution in routine PPI use beyond acid-related conditions due to limited evidence and substantial risks. It underscores the need for careful risk-benefit assessments and exploration of alternative therapies. Future research should aim to identify safer management strategies for portal hypertension complications and to develop evidence-based guidelines for PPI use in patients with cirrhosis.

Purpose of review: The integration of digital technology into medical practice is often thrust upon clinicians, with standards and routines developed long after initiation. Clinicians should endeavor towards a basic understanding even of emerging technologies so that they can direct its use. The intent of this review is to describe the current state of rapidly evolving generative artificial intelligence (GAI), and to explore both how pediatric gastroenterology practice may benefit as well as challenges that will be faced.

Recent findings: Although little research demonstrating the acceptance, practice, and outcomes associated with GAI in pediatric gastroenterology is published, there are relevant data adjacent to the specialty and overwhelming potential as professed in the media. Best practice guidelines are widely developed in academic publishing and resources to initiate and improve practical user skills are prevalent. Initial published evidence supports broad acceptance of the technology as part of medical practice by clinicians and patients, describes methods with which higher quality GAI can be developed, and identifies the potential for bias and disparities resulting from its use. GAI is broadly available as a digital tool for incorporation into medical practice and holds promise for improved quality and efficiency of care, but investigation into how GAI can best be used remains at an early stage despite rapid evolution of the technology.

Purpose of the review: The purpose of this review is to detail steps and strategies needed to have success as an interventional gastroenterologist at a tertiary care academic medical center.

Recent findings: Development of a specific niche within interventional endoscopy (IE), can allow an incoming academic interventional endoscopist to make a clinical and academic impact on a regional and national level. As the evolution of IE training continues, the development of a niche will become streamlined, supporting a more efficient academic progression for incoming IE faculty. By showcasing the experience of a junior academic interventional endoscopists, we demonstrate how expansion of a specific clinical interest within interventional endoscopy (IE), in conjunction with a mentoring environment, can facilitate academic and clinical progression at an academic medical center.