Endoscopy最新文献

Introduction Post-endoscopic resection (ER) management of high-risk T1 esophageal adenocarcinoma (EAC) is debated, with conflicting reports on lymph node metastases (LNM) We aimed to assess outcomes following radical ER for high-risk T1 EAC. Methods We identified patients who underwent radical ER (tumor-negative deep margin) of high-risk T1 EAC, followed by surgery or endoscopic surveillance, between 2008-2019 across 11 international centers. Results In total, 106 patients (86 men, 70 ±11 years) were included. Of these, 26 patients (64 ±11 yrs) underwent additional surgery, with residual T1 EAC in 5 (19%) and LNM in 2 (8%) cases. After median 47 (IQR 32-79) months follow-up, 2/26 (8%) developed LNM/distant metastasis (DM), with 1 (4%) EAC-related death. There was 1/26 (4%) unrelated death and 4/26 (15%) were lost to follow-up. Eighty patients (71 ±9 yrs) entered endoscopic surveillance. Over 46 (IQR 25-59) months follow-up, 5/80 (6%) developed LNM/DM, with 4/80 (5%) EAC-related deaths. There were 15/80 (19%) unrelated deaths, and 10/80 (13%) were lost to follow-up. Overall rates during follow-up were 6% (95% CI 2-12) for LNM, 7% (95% CI 3-13) for LNM/DM, 5% (95% CI 2-11) for EAC-related mortality, and 20% (95% CI 13-29) for overall mortality. Conclusion Our findings present low rates of LNM after radical ER of high-risk T1 EAC, consistent with other endoscopy-focused studies. Post-surgical patients are still at risk for metastasis and disease-specific mortality. These results suggest that endoscopic surveillance is suitable for selected cases, but further prospective studies are needed to refine patient selection and confirm optimal outcomes.

Background Timely detection of neoplasia in Barrett's esophagus (BE) remains challenging. While computer-aided detection (CADe) systems have been developed to assist endoscopists, their effectiveness depends heavily on the quality of the endoscopic procedure. This study introduces a novel computer-aided quality (CAQ) system for BE, evaluating its stand-alone performance and integration with a CADe system. Method The CAQ system was developed using 7,463 images from 359 BE patients. It assesses objective quality parameters (e.g., blurriness, illumination) and subjective parameters (mucosal cleanliness, esophageal expansion) and can exclude low-quality images when integrated with a CADe system. To evaluate CAQ stand-alone performance, the Endoscopic Image Quality test set, consisting of 647 images from 51 BE patients across 8 hospitals, was labeled for objective and subjective quality. To assess the benefit of the CAQ system as a preprocessing filter of a CADe system, the Barrett CADe test set was developed. It consisted of 956 video frames from 62 neoplastic patients and 557 frames from 35 non-dysplastic patients, in 12 Barrett referral centers. Results As stand-alone tool, the CAQ system achieved Cohen's Kappa scores of 0.73, 0.91, and 0.89 for objective quality, mucosal cleanliness, and esophageal expansion, comparable to inter-annotator scores of 0.73, 0.93, and 0.83. As preprocessing filter, the CAQ system improved CADe sensitivity from 82% to 90% and AUC from 87% to 91%, while maintaining specificity at 75%As preprocessing filter, the CAQ system improved CADe sensitivity and AUC from 82% and 87% to 90% and 91%. Conclusion This study presents the first CAQ system for automated quality control in BE. The system effectively distinguishes poorly from well-visualized mucosa and enhances neoplasia detection when integrated with CADe.

Difficult biliary cannulation (DBC) is a marker for prolonged procedure time and a higher rate of adverse events (AEs) during endoscopic retrograde cholangiopancreatography (ERCP). We previously showed that endoscopic ultrasound-assisted rendezvous (EUS-RV) procedures had a higher single-session success rate than precut papillotomy (PCP) in cases of DBC. The present randomized study aimed to compare the technical success and AE rates of the two approachesThis was an open-label randomized controlled trial in a tertiary care setting. Patients with malignant distal biliary obstruction (MDBO) and DBC were enrolled. The patients were randomized to PCP with a needle-knife or EUS-RV. The primary outcome was technical success; secondary outcomes were the AE rate, procedure duration, and length of hospital stay (LOS).208 patients were enrolled, 104 in each group. There were no statistically significant differences in technical success (93.3% PCP vs. 97.1% EUS-RV; P = 0.33; odds ratio [OR] 0.4, 95%CI 0.1-1.6) and overall AE rate (11.5% PCP vs. 5.8% EUS-RV; P=0.14; OR 0.5, 95%CI 0.8-5.9). Pancreatitis was higher in the PCP group (8.7% vs. 1.9%; P=0.06; OR 4.8, 95%CI 1.0-22.9). The mean duration of the procedure was significantly higher for EUS-RV (47 vs. 27 minutes; P<0.001). LOS was similar in the two groups (1.2 PCP vs. 1.1 days EUS-RV; P=0.25).Both PCP and EUS-RV have comparable rates of success, AEs, mortality, and LOS. EUS-RV could be used as an alternative to PCP in patients with MDBO and DBC.

Background and study aims: Non-lifting large non-pedunculated colorectal polyps (NL-LNPCPs) account for 15% of LNPCP and are effectively managed by Endoscopic Mucosal Resection with adjunctive Cold-forceps Avulsion with adjuvant Snare-Tip soft coagulation (CAST). However, recurrence rates > 10% at surveillance colonoscopy is a significant limitation. We aimed to compare the outcomes of CAST with MTA versus CAST alone for NL-LNPCPs.

Patient and methods: Prospective observational data on consecutive patients with NL-LNPCPs treated by EMR and CAST at a single tertiary center was retrospectively evaluated. Two cohorts were established: the pre-MTA period (January 2012-June 2017) and the MTA period (July 2017-October 2023). The primary outcome was the residual/recurrent adenoma (RRA) rate at first surveillance colonoscopy (SC1). Secondary outcomes included RRA at SC2 and adverse events.

Results: Over 142 months, 300 patients underwent EMR and CAST for LNPCP: 103 lesions pre-MTA and 197 with MTA. At SC1 and SC2, recurrence was lower in the MTA cohort compared to the pre-MTA cohort (5.0% vs. 18.8%, p<0.001 and 0.8% vs. 10.0%, p<0.001, respectively). Adverse events were similar between the two cohorts [deep mural injury types III-V (pre-MTA 2.9% vs MTA 5.6%, p=0.29), delayed bleeding (pre-MTA 8.7% vs MTA 7.1%, p=0.49)]. On multivariate analysis, MTA was the only variable independently associated with a reduced likelihood of recurrence (OR 0.20, 95% CI 0.07-0.54; P = 0.001).

Conclusions: For NL-LNPCPs, MTA in combination with CAST is safe and effective and reduces recurrence at SC1 in comparison to CAST alone.

Background: Portal venous circulating tumor cells (CTCs) detection may better reflect vascular metastasis and predict micro-metastasis risk in PDAC than peripheral blood. We hypothesize that portal CTCs could better represent micro-metastasis and predict survival in PDAC patients.

Methods: A single-center, prospective cohort study of patients with stage I-III PDAC was conducted. Portal venous blood was obtained via EUS-guided sampling, and peripheral blood was collected on the same day. CTCs were detected using EpCAM and mucin1 antibodies and reported as cells/8mL of blood.

Results: Among 35 patients, portal and peripheral CTC detection rates were 94.3% and 82.9%, respectively. Advanced PDAC with loco-regional metastasis had higher portal CTCs than less aggressive disease (p<0.05), while peripheral CTCs showed no significant differences. During the 50-month follow-up, patients with portal CTCs≥8 had poorer survival (6.1 vs. 19.0 months, p=0.001) and patients with peripheral CTCs≥3 also had poorer survival (4.6 vs. 14.2 months, p=0.002). In multivariable analysis, both portal CTCs≥8 and peripheral CTCs≥3 showed significant adjusted associations with survival (aHRs 3.39 and 2.71; p=0.009 and 0.020).

Conclusion: Higher CTC counts in both portal and peripheral systems were significantly associated with poorer survival in stage I-III PDAC; however, only portal CTCs reflected tumor aggression and loco-regional metastasis.

Background and study aims: While artificial intelligence (AI) shows high potential in decision support for diagnostic gastrointestinal endoscopy, its role in therapeutic endoscopy remains unclear. Third space endoscopic procedures pose the risk of intraprocedural bleeding. Therefore, we aimed to develop an AI algorithm for intraprocedural blood vessel detection.

Patients and methods: Using a test dataset with 101 standardized video clips containing 200 predefined submucosal blood vessels, 19 endoscopists were evaluated for the vessel detection rate (VDR) and time (VDT) with and without support of an AI algorithm. Test subjects were grouped according to experience in ESD.

Results: With AI support, endoscopists VDR increased from 56.4% [CI 54.1-58.6] to 72.4% [CI 70.3-74.4]. Endoscopists' VDT dropped from 6.7sec [CI 6.2-7.1] to 5.2sec [CI 4.8-5.7]. False positive (FP) readings appeared in 4.5% of frames and were marked significantly shorter than true positives (6.0sec [CI 5.28-6.70] vs. 0.7sec [CI 0.55-0.87]).

Conclusions: AI improved the vessel detection rate and time of endoscopists during third space endoscopy. While these data need to be corroborated by clinical trials, AI may prove to be an invaluable tool for the improvement of endoscopic interventions.