Endoscopy最新文献

Background and aims: Difficult biliary cannulation (DBC) is a marker for prolonged procedure time and increased adverse event rate (AER) during endoscopic retrograde cholangiopancreatography (ERCP). We previously showed that EUS-guided rendezvous procedure (EUS-RV) had a higher single session success rate than precut papillotomy (PcP) in DBC patients. The present randomized study aims at comparing the technical success and AER between the two approaches.

Methods: This was an open label randomized controlled trial at a tertiary care setting. Patients with Malignant distal biliary obstruction and DBC were enrolled. The patients were randomized to PcP with needle knife or EUS-RV. The primary outcome was technical success, secondary outcomes were AER, procedure duration and length of hospital stay (LOS).

Results: A total of 208 patients were enrolled, 104 in each group. There was no statistically significant difference in technical success (93.27% PcP vs 97.12% EUS-RV, p=0.33, 95%CI: 0.104-1.63) and overall AER (11.54% PcP vs 5.77% EUS-RV, p=0.14, 95%CI: 0.77-5.91). Pancreatitis was higher in the PcP group (8.65% vs 1.92%, p=0.058, OR= 4.83, 95%CI: 1.02-22.93). Mean duration of procedure was significantly higher for EUS-RV (47.15mins vs 27.17 min, p<0.00001, 95%CI: 18.6821.94). LOS was similar in the two groups (1.216 PcP vs 1.109 days EUS-RV, p =0.249).

Conclusion: Both PcP and EUS-RV have comparable success, AER, mortality, and LOS. EUS RV could be used as an alternative to PcP in patients with malignant distal biliary obstruction and DBC.

A modified double-layered suturing procedure (origami method; OGM) can achieve robust closure, even for large mucosal defects, by folding the muscle layer using through-the-scope clips. This study aimed to evaluate the feasibility of OGM in duodenal endoscopic submucosal dissection (ESD).This retrospective, observational study was conducted at a tertiary care hospital. We reviewed cases of OGM attempted after duodenal ESD between June 2022 and April 2023. We excluded lesions located in the duodenal bulb or involving the major papilla. We measured the clinical characteristics and outcomes.OGM was attempted in 28 cases after duodenal ESD. The median mucosal defect size was 38 mm (range 26-110). Complete closure was achieved in 27 cases (96%), including the largest lesion. The median closure time was 16 minutes. There were no perforations caused by clips. Delayed perforation and bleeding were not observed. Among 28 cases, 21 underwent follow-up endoscopy 3-5 days after ESD, and the muscle layer remained folded in all cases.OGM achieved a high rate of complete closure even after duodenal ESD. Closure with OGM was robust enough to maintain the folded muscle layer for at least 3 days postoperatively.

Accurate size measurement of colorectal polyps is critical for clinical decision making and patient management. This systematic review aimed to evaluate the current techniques used for colonic polyp measurement to improve the reliability of size estimations in routine practice.A comprehensive literature search was conducted across PubMed, EMBASE, and MEDLINE to identify studies relevant to size measurement techniques published between 1980 and March 2024. The primary outcome was the accuracy of polyp sizing techniques used during colonoscopy.61 studies were included with 34 focusing on unassisted and assisted endoscopic visual estimation and 27 on computer-based tools. There was significant variability in visual size estimation among endoscopists. The most accurate techniques identified were computer-based systems, such as virtual scale endoscopes (VSE) and artificial intelligence (AI)-based systems. The least accurate techniques were visual or snare-based polyp size estimation. VSE assists endoscopists by providing an adaptive scale for real-time, direct, in vivo polyp measurements, while AI systems offer size measurements independent of the endoscopist's subjective judgment.This review highlights the need for standardized, accurate, and accessible techniques to optimize sizing accuracy during endoscopic procedures. There is no consensus on a gold standard for measuring polyps during colonoscopy. While biopsy forceps, snare, and graduated devices can improve the accuracy of visual size estimation, their clinical implementation is limited by practical, time, and cost challenges. Computer-based techniques will likely offer improved accuracy of polyp sizing in the near future.

We aimed to evaluate the association between colonoscopy and colorectal cancer (CRC) occurrence and related mortality in an older population.This retrospective, nationwide, population-based cohort study used data of adults aged ≥40 years from the Health Insurance Review and Assessment Service database. After excluding colonoscopy within 6 months of CRC diagnosis during enrollment, CRC occurrence and related mortality were compared between colonoscopy and non-colonoscopy groups using a time-dependent Cox proportional hazard model. Subgroup analysis was conducted among four age groups: young, middle-aged, old, and very old.Among 748986 individuals followed for 9.64 (SD 0.99) years, the colonoscopy group had a 65% lower CRC occurrence (adjusted hazard ratio [HRa] 0.35, 95%CI 0.32-0.38) and 76% lower CRC-related mortality (HRa 0.24, 95%CI 0.18-0.31) after 5 years compared with the non-colonoscopy group. Colonoscopy was associated with the most significant reduction in CRC occurrence in the middle-aged group (HRa 0.32, 95%CI 0.29-0.35) and in CRC-related mortality in the young group (HRa 0.04, 95%CI 0.01-0.33); the very old group had the least reduction in both CRC occurrence and CRC-related mortality (HRa 0.44, 95%CI 0.33-0.59 and HRa 0.28, 95%CI 0.15-0.53, respectively).We found a significant association between colonoscopy and reduction in CRC occurrence and CRC-related mortality in adults aged ≥40 years after 5 years of follow-up; however, these associations were weaker in the very old group. More research is needed on the association between colonoscopy and older age.