Endoscopy International Open最新文献

Background and study aims: Benign biliary strictures (BBS) are commonly managed by progressive calibration using plastic or metallic stents. Although fully-covered metallic stents (FC-SEMS) enable immediate calibration to a larger diameter compared with plastic stents, they remain prone to migration and use is limited in intrahepatic and peri-hilar strictures. We report on using uncovered expandable bioresorbable stents (BRES) in a series of selected BBS patients.

Patients and methods: This retrospective monocentric case series included all consecutive patients treated between 2023 and 2024. Patients were highly selected for uncommon situations for which usual stents were not well suited and followed for at least 12 months after the procedure. Technical success, clinical success, and adverse events (AEs) were systematically recorded.

Results: Five procedures were performed in five patients with implantation of a total of eight UNITY-B stents. Three patients underwent internalization of an internal-external drainage across a bilio-digestive anastomotic stricture. One patient was treated with retrograde extra-anatomical endoscopic drainage for an anastomotic stricture. One patient underwent calibration of an intrahepatic stricture following radiofrequency of an IPMN-B. Technical success was achieved in all cases (100%), with clinical success observed in 80% of patients. No AEs were observed.

Conclusions: Use of bioresorbable UNITY-B stents appears feasible and safe for selected benign biliary strictures, including in intrahepatic locations. Further studies are needed to confirm these preliminary findings.

Background and study aims: Current European and American guidelines conflict in their recommendations for surveillance versus endoscopic therapy for low-grade dysplastic Barrett's (LGD). We aimed to evaluate the performance of a selective management algorithm and provide real-world outcomes.

Patients and methods: Data on 497 patients with dysplastic Barrett's were collected prospectively between 2008 and 2022 at a Barrett's referral unit. LGD was defined as confirmation of LGD by an expert gastrointestinal pathologist. Persistent unifocal LGD or multifocal LGD were considered high-risk features for progression and patients underwent endoscopic eradication therapy (EET). Patients with non-persistent unifocal LGD were deemed low-risk and were surveilled. Primary outcome was progression rate to high grade dysplasia or neoplasia.

Results: A total of 135 patients had LGD (median [interquartile range] follow up: 4.8 years [1.0-7.1]): 22 patients met low-risk criteria and were surveilled (LR-S), eight patients met high-risk criteria and were surveilled (HR-S; patient preference n = 4, medical comorbidities n = 4), and 105 patients met high-risk criteria and underwent EET (HR-EET). Progression rates were similar between the LR-S and HR-EET cohorts (4.5% [n = 1/22] vs. 6.7% [n = 8/105]; P = 0.43). The HR-S group had a significantly higher progression rate (25% [n = 2/8]; P = 0.04). Univariable analysis showed reflux esophagitis (sub-distribution hazard ratio 3.21, 95% confidence interval 1.02-10.1, P = 0.04) was associated with progression risk in the high-risk LGD cohort only.

Conclusions: This selective management algorithm for LGD is safe. Surveillance is appropriate in low-risk LGD patients. Patients with high-risk features who are surveilled and/or have reflux esophagitis may have an increased progression risk and should undergo EET with optimized acid suppression therapy.

Background and study aims: Fully covered self-expandable metal stents (FCSEMSs) provide durable preoperative biliary drainage in pancreatic cancer but may increase risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). We evaluated whether groove involvement was an independent anatomical PEP risk factor and compared PEP incidence after 8-mm FCSEMS and plastic stent (PS) placement using propensity-score-based inverse probability of treatment weighting (IPTW).

Patients and methods: Sixty-two consecutive patients with resectable or borderline resectable pancreatic cancer and distal biliary strictures with naïve papillae underwent ERCPs between February 2015 and August 2024. An 8-mm FCSEMS or PS (7-11.5F) was placed. Independent PEP predictors were identified using multivariable Firth logistic regression. PEP incidence was compared between stent types after IPTW adjustment for age, sex, clinical stage, groove involvement, main pancreatic duct diameter, and prophylactic pancreatic-stent placement.

Results: Mean age was 73.3 ± 8.2 years (62.9% male). Groove-area extension was present in 21.0% of tumors. PEP occurred in six patients (9.7%), all after FCSEMS placement. Groove involvement independently predicted PEP (adjusted odds ratio, 14.7; 95% confidence interval, 2.26-95.9; P = 0.005). After IPTW, the weighted PEP rate remained higher with FCSEMS than PS (13.4% vs 0%; P = 0.011).

Conclusions: Groove-area tumor extension is an independent imaging-detectable PEP risk factor. Even after baseline difference adjustment, 8-mm FCSEMS placement was associated with a higher pancreatitis risk than PS placement. Pre-procedural groove involvement identification may guide stent selection and support selective prophylactic pancreatic stenting. However, further confirmation through larger prospective studies is required.

Background and study aims: Endoscopic sphincterotomy (EST) is important in endoscopic retrograde cholangiopancreatography, but bleeding remains its common complication. This pilot study evaluated the efficacy and safety of a self-assembling peptide hydrogel (SAPH; PuraStat) in managing EST-related hemorrhage.

Patients and methods: A prospective cohort study was conducted from June 2023 to March 2024 at three hospitals in Japan, enrolling patients undergoing EST. Patients were divided into SAPH (received SAPH for EST-related bleeding) and control groups (patients without EST-related hemorrhage); primary endpoint was incidence of delayed bleeding.

Results: Of the 254 patients analyzed, 27 were in the SAPH group and 227 in the control group. Background factors related to bleeding were aligned using propensity score matching (PSM). Incidence of EST-related bleeding was 10.6% (27/254). In the SAPH group, 26 of 27 patients (96.3%) achieved successful hemostasis using SAPH alone. Although no delayed bleeding occurred in this group, it occurred in four patients in the control group (1.57%, 4/254). Other adverse events showed no significant difference between the groups. Results were similar to those after PSM and in the subgroup analysis excluding those with self-expandable metallic stent placement.

Conclusions: SAPH is a simple, effective, and safe hemostatic option for treating EST-related hemorrhage and may be a promising first-line approach. This pilot study did not demonstrate a significant reduction in delayed bleeding, but absence of delayed bleeding in the SAPH group is noteworthy and suggests a potential preventive benefit. Thus, larger randomized controlled trials are warranted to validate these preliminary findings.

Background and study aims: Comparison of the therapeutic effects of endoscopic botulinum toxin (BTX) injection and semaglutide (SME) injection in treatment of patients with obesity and weight regain after laparoscopic sleeve gastrectomy (LSG).

Patients and methods: The injection method for botulinum toxin is to dilute 300 U of type A botulinum toxin with 20 mL of physiological saline. Injections were made in a grid pattern throughout the antrum and body (20 injection points total), with 1 mL of drug injected at every point. The application method for semaglutide injection is to start at 0.25 mg once a week and increase by 0.25 mg every 3 weeks until the patient can tolerate the maximum dose (1.0 mg qw), for a total of 6 months.

Results: The weight loss effect of the SME group was significantly better than that of the LSG+SME group because the SME group achieved significantly greater weight loss at 2 months than the LSG+SME group. No significant difference was seen between any other pair of groups.

Conclusions: Endoscopic botulinum toxin injection can be a safe and effective treatment for weight regain after LSG.

Background and study aims: Endoscopic full-thickness resection (EFR) of gastric stromal tumors carries a high peritonitis risk. Our case report implied the preset pursestring procedure (PPP) could boost EFR speed and safety, but supporting clinical evidence is lacking, prompting this clinical evaluation of PPP in gastric EFR.

Patients and methods: This retrospective cohort study analyzed adults with small gastric stromal tumors who underwent EFR (n = 31) or PPP-assisted EFR (PPP-EFR, n = 28) between August 2022 and August 2023. Tumor characteristics, adverse events, postoperative efficacy, economic outcomes, and follow-up data were compared between groups.

Results: R0 resection rates were comparable (PPP-EFR: 92.8%; EFR: 90.0%). PPP-EFR had shorter closure time (3.5 vs. 19.5 min, P = 0.001). PPP-EFR had lower incidence of postoperative fever (10.7% vs. 32.3%, P = 0.040), computed tomography-confirmed peritonitis (7.1% vs. 29.0%, P = 0.031), and elevated inflammatory markers ( P ≤ 0.003), plus shorter fasting time ( P = 0.038). Operative time, hospital stay, and cost did not differ; no patients had recurrence or metastasis on follow-up.

Conclusions: PPP optimizes EFR closure, reduces inflammatory and abdominal complications, and improves postoperative recovery for small gastric stromal tumors.