Endoscopy International Open最新文献

Background and study aims: This study aimed to evaluate interobserver and intraobserver agreement in Size/Morphology/Site/Access (SMSA) scoring among practicing endoscopists with varying levels of experience.

Patients and methods: A total of 102 fully independent endoscopists participated in the study. Ten short video clips of colonic polyps of varying size and complexity were recorded using Olympus 290 colonoscopes and included white light, near focus, narrow band imaging, and chromoendoscopy where applicable. These videos were embedded in an online questionnaire. Endoscopists were asked to assign SMSA scores based on three variables-size, morphology, and access-with the site provided for standardization. A subgroup of five participants repeated the assessment after 2 to 3 weeks to evaluate intraobserver consistency. Data were analyzed using Fleiss' kappa via SPSS (v26), and Kappa interpretation followed the Landis and Koch classification.

Results: Overall interobserver agreement for SMSA level across all participants was fair (κ = 0.346). Among individual parameters, morphology had the highest agreement (κ = 0.505, moderate), followed by access (κ = 0.408, moderate) and size (κ = 0.241, fair). Subgroup analysis of experienced endoscopists (> 1000 lifetime colonoscopies) yielded slightly improved kappa values, with morphology still demonstrating the highest consistency. Intraobserver agreement showed moderate to almost perfect reliability for size (κ = 0.444 to 1.000) and moderate to substantial agreement for SMSA level (κ = 0.429 to 0.846).

Conclusions: Morphology was the most consistently scored parameter. Although the SMSA tool remains valuable, efforts such as standardized training and simplification of variable categories may be warranted to improve interobserver consistency and enhance clinical-utility.

Background and study aims: The eCura system has been shown to accurately delineate early gastric cancers with negligible risk of lymph node metastases, which, therefore, would be considered endoscopically cured. However, this classification was based predominantly on data from high-incidence Eastern countries. We sought to assess whether these criteria can be safely applied in a Western population.

Patients and methods: Data were retrospectively recorded for patients who underwent gastrectomy in four Australian tertiary centee over two decades. Demographic data, lesion characteristics (size, differentiation, invasion depth, lymphovascular invasion, and ulceration) as well as number of lymph node metastases was recorded. Patients given neoadjuvant chemotherapy were excluded.

Results: A total of 1,465 gastrectomy specimens were reviewed, including in 558 patients who underwent resection of gastric adenocarcinoma without neoadjuvant chemotherapy (mean age 67.9, 64.2% male). Of these, 101 (18.1%, confidence interval [CI] 15.4%-21.9%) had T1 disease (T1a = 30, T1b = 71). Of the lesions, 11.5% (n = 64, CI 9.1%-14.4%) met the 2021 Japanese "absolute criteria" for endoscopic resection, with 7.8% of these (n = 5, CI 3.4%-17%) having positive lymph nodes at gastrectomy. Of them, 9.9% (n = 55, CI 7.6%-12.6%) would have been considered eCura A or B, with none of these having positive lymph nodes at gastrectomy.

Conclusions: The eCura system for defining endoscopic curability could have been safely applied in this Western population. Even in Western countries, patients with early gastric cancer that meets Japanese guidelines for endoscopic resection should, where possible, undergo en bloc endoscopic submucosal dissection. Lesions classified histologically as eCuraA or B should be considered endoscopically cured.

Background and study aims: Axis deviation and helical stricture following sleeve gastrectomy may result in functional gastric outlet obstruction, leading to significant patient morbidity. Conventional endoscopic therapies, such as balloon dilation and self-expandable metal stents (SEMS), have demonstrated limited efficacy and are frequently associated with recurrence and complications. This study aimed to assess clinical outcomes of endoscopic stricturotomy as a minimally invasive technique for managing axis-related stenosis after sleeve gastrectomy.

Patients and methods: This retrospective case series included adult patients (≥ 18 years) who underwent endoscopic stricturotomy for axis-related stenosis at a tertiary academic center from 2019 to 2024. Diagnosis of helical stricture was confirmed via endoscopic and radiologic assessments. Clinical data were obtained through electronic chart review and structured telephone interviews. Symptom severity was evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using a visual analog scale (VAS). Statistical analysis included the Shapiro-Wilk test and paired t-test or Wilcoxon signed-rank test, with P < 0.05 considered significant.

Results: Eight patients (mean age 53 years; 62.5% female) were included, with a mean time of 31.3 months between surgery and stricturotomy. All GCSI domains showed significant symptom improvement. The global GCSI score improved from 35.44 to 21.66 ( P = 0.014), and VAS scores increased from 3.0 to 7.75. Complications included two cases of intraoperative pneumoperitoneum and one delayed gastric fistula, all managed non-surgically.

Conclusions: Endoscopic stricturotomy is a promising, minimally invasive treatment for axis-related gastric outlet obstruction post-sleeve gastrectomy. Prospective studies are warranted to confirm long-term outcomes.

Background and study aims: Evidence on gastric endoscopic submucosal dissection (ESD) under glucocorticoids or immunomodulators (GC/IM) is limited. We evaluated whether GC/IM use affects gastric ESD outcomes.

Patients and methods: We retrospectively analyzed 411 consecutive ESDs (April 2017-April 2022). GC/IM users (n = 32) were compared with controls (n = 379); 1:3 propensity-score matching yielded 27 vs 81 patients. The primary outcome was overall complications, defined as a composite of pain, fever, delayed bleeding, and delayed perforation. Secondary outcomes were each component, intra-procedure perforation, hospital stay, and use of symptom-directed treatments (analgesics, antipyretics, antibiotics).

Results: Overall complications were more frequent with GC/IM than controls (44.4% vs 21.0%; P = 0.024; relative risk [RR] 2.11, 95% confidence interval 1.16-3.84), driven by pain (40.7% vs 18.5%; P = 0.035) and fever (11.1% vs 1.2%; P = 0.047). Rates of major complications did not differ (delayed bleeding 3.7% vs 2.5%; delayed perforation 0% vs 0%). Intra-procedure perforation was numerically higher (7.4% vs 3.7%) without significance. Median (interquartile range) hospital stay showed a small, non-significant difference (9 [7-12] vs 8 [7-9] days; P = 0.064). Symptom management was used more often with GC/IM (analgesics 25.9% vs 3.7%, P = 0.002; antipyretics 7.4% vs 2.5%, P = 0.270; antibiotics 7.4% vs 3.7%, P = 0.597).

Conclusions: In patients receiving GC/IM, gastric ESD was associated with a higher incidence of minor, clinically managed events-chiefly pain and transient fever-whereas major complications remained uncommon. With close monitoring and prompt symptom-directed care, gastric ESD appeared clinically feasible, albeit with slightly greater resource use and observation time.

Background and study aims: Scissor-type knives have shown safety and efficacy in endoscopic submucosal dissection (ESD) procedures, particularly in studies from Japan. However, the safety and efficacy of these devices in international settings, particularly outside Japan, is not well established.

Patients and methods: This was a prospective, multicenter, observational study conducted across nine international centers, encompassing a total of 461 lesions from 460 patients. In subgroup analysis, 162 lesions came from four institutions in Japan (Japanese institutions group, JAG) and 299 lesions from five institutions outside Japan (non-Japanese institutions group [NJAG]). After 1:1 propensity score matching resulted in 120 matched pairs of lesions, key outcomes were compared between groups.

Results: The overall perforation rate during ESD procedures was 0.87%. Intraoperative perforations were observed more frequently in NJAG than JAG (3 vs. 1 event, 1.9% vs. 0.33%, respectively), although not statistically significant ( P = 0.127). Overall incidence of delayed bleeding was also 0.87%, with no delayed bleeding reported in NJAG. Post propensity matching analysis revealed a significantly slower median resection speed in NJAG compared with JAG (9.12 0.86-56.57 vs 26.21 1.95-93.54 mm²/min, P < 0.001). Both histological complete resection and curative resection rates were significantly lower in NJAG than in JAG with rates of 88.3% vs 98.3% for histological complete resection and 83.3% vs 95% for curative resection (both P < 0.01).

Conclusions: Use of scissor-type knives in colorectal ESD outside Japan demonstrated a favorable safety profile. However, certain performance outcomes, such as resection speed and resection success rates, were inferior to Japanese institutions.

Endoscopic ultrasonography-guided gallbladder drainage (EUS-GBD) using the current plastic stent (PS) system requires multiple steps for stent deployment and carries the risk of bile leakage from the puncture site. In this study, we developed a single-step PS system that includes a 3F electrocautery metal tip on the inner sheath mounted with a 7F/4-cm double-pigtail PS and experimentally evaluated it on a gallbladder model mimicking EUS-GBD. We assessed procedure time, intra-gallbladder pressure-drop ratios, and bile leakage using a newly developed single-step PS system, comparing it with the current PS system during drainage attempts on a gallbladder model. Mean duration times for the three attempts were 2 minutes 59 seconds and 27 seconds for the current PS system and the newly developed PS system groups, respectively ( P < 0.001). Mean intra-gallbladder pressure-drop ratios were 86.7% in the current PS system group and 7.6% in the newly developed PS system group ( P < 0.001). The newly developed PS system prevented bile leakage from the puncture site. The newly developed PS system saved significant time, maintained intra-gallbladder pressure, and prevented bile leakage during the procedure when compared with the current PS system.

Background and study aims: Biliary stents are widely used in endoscopic retrograde cholangiopancreatography (ERCP), yet their impact on the native bile microbiome under non-infectious conditions remains unclear. We aimed to characterize stent-associated alterations in the biliary microbiome using 16S rRNA gene sequencing.

Patients and methods: We analyzed bile samples collected during ERCP from 35 patients without clinical or laboratory evidence of acute cholangitis. Patients were categorized into a control group (n = 25; naïve papillae) and an endoscopic biliary stenting (EBS) group (n = 10; previously stented). Microbial composition was assessed using high-throughput 16S rRNA sequencing after propensity score matching to balance background characteristics.

Results: Beta diversity differed significantly between groups (PERMANOVA, P < 0.01), despite no significant differences in alpha diversity. The EBS group demonstrated increased relative abundance of Firmicutes and Fusobacteriota , and depletion of Proteobacteria . Notably, Enterococcus was significantly enriched in the EBS group (log fold change 6.74; q < 0.01), whereas Sphingomonas was reduced.

Conclusions: Endoscopic biliary stenting is associated with distinct bile microbiome alterations, characterized by enrichment of Enterococcus species in clinically stable patients. These findings suggest that stents may predispose to opportunistic colonization, providing a potential mechanistic link to future cholangitis. Recognizing such preclinical dysbiosis may inform tailored antimicrobial strategies and future stent design.

Background and study aims: Self-expandable metallic stent (SEMS) placement is an established intervention for malignant colorectal obstruction, but the ileocecal region presents unique anatomical challenges. This study aimed to evaluate the technical success of SEMS placement for malignant ileocecal obstruction and to examine the impact of pre-stenting preparation and device selection.

Patients and methods: We retrospectively analyzed 72 patients with right-sided malignant colonic obstruction (13 ileocecal, 59 other segments) treated between January 2011 and March 2025. The primary outcome was the technical success rate; procedure efficiency was the secondary outcome. Clinical success was also evaluated in the ileocecal group according to treatment intent. All ileocecal cases underwent contrast liquid enema-assisted navigation (CLEAN) to assist device selection. Subgroup analyses examined scope diameter, hood shape, operator experience, and catheter tip mobility.

Results: Technical success was significantly lower in the ileocecal group (76.9% vs. 98.3%, P = 0.017), whereas median procedure times were similar (40.0 vs. 35.0 minutes, P = 0.934). In the ileocecal group, all patients with technical success also achieved clinical success. No major complications occurred. Tapered hoods significantly shortened procedure time (26.0 vs. 50.0 minutes, P = 0.018), and expert operators completed procedures faster than trainees (30.5 vs. 58.0 minutes, P = 0.042). Although movable-tip catheters and smaller-diameter scopes showed no statistical differences, selected cases demonstrated procedure advantages.

Conclusions: SEMS placement in the ileocecal region is technically more challenging than in other right-sided segments. Procedure optimization - potentially aided by CLEAN, tapered hoods, and experienced operators-may help overcome anatomical difficulties while maintaining safety.

Background and study aims: Light-emitting diodes are being developed as a light source for an endoscope system instead of xenon lamps, contributing to improved diagnostic capability. This system also has the advantage of consuming less power than a conventional endoscope system using xenon lamps. Power consumption associated with endoscopy is an important factor in reducing greenhouse gas emissions. This study estimated the reduction in greenhouse gas emissions by using a light-emitting diode endoscope system.

Methods: We calculated the power consumption and carbon dioxide emission reduction of the light-emitting diode endoscope system in comparison with a conventional endoscope system using a xenon light source. Calculations were based on actual data regarding operating time and the annual number of endoscopic procedures at Jichi Medical University Hospital. Estimates were also extended to a nationwide scale.

Results: If each type of endoscope system were used for all endoscopic procedures, the light-emitting diode endoscope system would reduce power consumption by 49% compared with the xenon endoscope system, resulting in a total power reduction of 838.7kWh, equivalent to 394.2 kg of carbon dioxide emissions. In Japan, the total power consumption would be reduced by 53%, corresponding to a total power reduction of 428,628.8 kWh, equivalent to 201,455.5 kg of carbon dioxide emissions.

Conclusions: We estimated the effect of reducing carbon dioxide emissions using the light-emitting diode endoscope system. Wider adoption of the light-emitting diode endoscope system is expected to contribute to usefulness of endoscopic diagnosis and reduction in environmental impact.