Endoscopy International Open最新文献

Background and study aims: Missed high-grade dysplasia (HGD) or adenocarcinoma in Barrett's esophagus (BE) may have serious consequences, although the attributes of post-endoscopy Barrett's neoplasia (PEBN) remain unexplored. We analyzed the characteristics of Barrett's neoplasia (BN) eluding detection during screening endoscopy.

Methods: We retrospectively reviewed endoscopic images of BN, including HGD and adenocarcinoma, diagnosed at six centers in Nagano prefecture. Eligible patients had index endoscopic images obtained 7 to 36 months before BN diagnosis. Causes of PEBN were classified as perceptual error, in which BN was missed despite images taken where it was eventually diagnosed, or exposure error, whereby no images were obtained in the area of BN development.

Results: Among the 91 patients with BN, 31 were judged as having PEBN. The majority of PEBN cases were attributed to perceptual error (22 patients, 71%). Lesions within long-segment BE (LSBE) were significantly more likely to be overlooked due to exposure error (67% vs. 18%, P = 0.02), whereas lesions at the 0 to 3 o'clock position in short-segment BE (SSBE) tended to be missed due to perceptual error (76% vs. 33%, P = 0.04). Notably, 39% of perceptual error cases were misdiagnosed as esophagitis on index endoscopy. In the nine patients requiring surgery for PEBN, eight cases were attributed to perceptual error.

Conclusions: PEBN occurring in LSBE was mostly overlooked because of inadequate observation, whereas PEBN at the 0 to 3 o'clock position in SSBE was frequently misdiagnosed as esophagitis. Bearing these results in mind may improve quality of endoscopic screening and reduce incidence of PEBN.

Background and study aims: Biliary drainage is performed in palliative malignant biliary obstruction (MBO) to improve patient quality of life and enable chemotherapy. This study aimed to create and validate a prognostic score after biliary drainage in patients with palliative MBO.

Patients and methods: Patients undergoing endoscopic or percutaneous drainage for palliative MBO were included in a multicenter, retrospective study. Probability factors associated with 30-day mortality were evaluated by univariable and multivariable logistic regression in the derivation cohort and a prognostic score was built and evaluated in an independent validation cohort.

Results: The derivation cohort included 262 patients, 55% male, 61% of whom had pancreatic adenocarcinoma, mean age 72 years. Probability factors associated with 30-day mortality identified in the derivation cohort were World Health Organization performance status of 3-4 (odds ratio [OR] 7.7 [2.57-25.0] ; +3 points), liver metastases (OR 2.7 [1.06-6.98] ; +1 point), other metastases (OR 3.85 [1.57-9.97] ; +2 points), leukocytes >12G/l (OR 2.4 [0.94-6.08]; +1 point), total bilirubin > 10.8 mg/dL (OR 4.3 [1.45-15.20] ; +2 points) and creatininemia > 5.0 mg/dL (OR 7.3 [2.89-19.86]; +3 points). The multivariable model showed good discrimination, with an area under the receiver operating curve (AUROC) of 0.86 (95% confidence interval 0.80-0.93). The prognostic score was used to define two groups of patients, with a low (0-4 points) or high-probability (> 4 points) of 30-day mortality (3% and 32%, respectively). The AUROC in the validation cohort (192 patients) was 0.72, with 30-day mortality of 7% in the low- probability group and 22% in the high- probability group ( P = 0.02).

Conclusions: This score could be used in routine clinical practice to identify patients who have better survival outcomes after biliary drainage in palliative MBO.

Background and study aims: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is a nonsurgical treatment option for managing pancreatic lesions. We sought to evaluate the safety and efficacy of EUS-RFA for large (≥4 cm) branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs).

Patients and methods: Patients with a definitive diagnosis of BD-IPMN who declined or were unfit for surgery underwent EUS-RFA in a single-arm prospective trial. Ablation was performed using a 19G EUS-RFA needle. RFA applications were delivered up to a maximum threshold of 45 seconds or 400 ohms impedance. Safety was assessed using AGREE guidelines. Potential for efficacy was assessed using cyst volume and cyst fluid KRAS GNAS mutations using next-generation sequencing (NGS). Adverse events (AEs) were analyzed per RFA session, while response was analyzed per BD-IPMN.

Results: Thirty BD-IPMNs (mean diameter 4.6 ± 1.7 cm; 80% multilocular) in 25 participants (mean age 74.1 ± 8.3 years) underwent 41 EUS-RFA sessions. AEs occurred in 12.2% of procedures (5/41), the majority being AGREE Grade 3A (9.8%, 4/41). During a mean follow-up of 18 ± 5 months, 22 of 28 BD-IPMNs (78.6%) achieved ≥ 50% reduction in cyst volume, and 11 (39.3%) demonstrated complete (≥90%) response. Among 26 BD-IPMNs that revealed KRAS GNAS mutations, follow-up NGS was performed in 17, with 88.2% showing loss of detectable mutations.

Conclusions: EUS-RFA in large, predominantly multilocular BD-IPMNs shows promising volumetric efficacy. Safety may be improved through refined energy delivery and technical advances. Molecular response remains exploratory and requires further validation. Long-term studies assessing progression-free outcomes are needed to define its role as an organ-preserving therapeutic option.

Background and study aims: Data on survival for elderly Western patients undergoing endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) are scarce.

Patients and methods: A multicenter, prospective, cohort study (2016-2022) was conducted in 26 Spanish hospitals that included patients aged > 70 years treated with ESD for EGC. The primary endpoint was overall survival in octogenarians compared with the previous decade; secondary outcomes included safety and technical success.

Results: A total of 217 patients were included, 135 in their 70s (Group A) and 82 in their 80s (Group B). Group B had higher comorbidity (73.2% vs 46.7%; P < 0.001) and greater anticoagulant use (39.5% vs 17.3%; P < 0.001). Technical success and intraprocedural adverse events were similar, but delayed bleeding was higher in Group B (22.8% vs 8.2%; P = 0.003). No intraprocedural deaths occurred, but three patients in Group B (3.6%) died within 30 days (2 post-ESD, 1 post-surgery). Of 169 patients followed (77.9%), 28 died (16%), including two cancer-related deaths in Group B. Five-year overall survival (OS) was 78% in Group A and 57% in Group B ( P = 0.03); median survival in Group B was 58.5 months. Multivariate analysis identified American Society of Anesthesiologists performance status (ASA-PS) ≥ III as the only independent risk factor for lower OS (hazard ratio 3.9; 95% confidence interval 1.3-11.3; P = 0.014).

Conclusions: Octogenarians with EGC benefit from ESD in a Western setting in terms of disease-free survival, but have lower long-term survival due to comorbidities, underscoring the importance of pre-procedure risk assessment. ESD is a proven safe technique, but in the subgroup of patients aged ≥ 80 years with severe comorbidities (ASA-PS ≥ IV), periprocedural mortality is increased and the indication should be carefully evaluated.

Background and study aims: Delay or absence of follow-up after luminal or pancreatobiliary stent placement can lead to adverse events. Few studies have investigated patient factors that impact compliance. The aim of this study was to identify patient-related predictors of compliance and non-compliance for luminal or pancreatobiliary stent removal at a single center.

Patients and methods: Patients who underwent esophagogastroduodenoscopy, endoscopic ultrasound, and/or endoscopic retrograde cholangiopancreatography with temporary stent placement for disease from March 2020 to March 2024 were included. Compliance was defined as stent removal or imaging confirming stent passage within 6 months (plastic stents or any cystgastrostomy stents) or 12 months (metal biliary stents) of the index procedure. Social and demographic risk factors potentially associated with stent removal and non-compliance were analyzed.

Results: One hundred fifty-one cases fit the inclusion criteria, of which 118 involved compliant patients (78%) and 33 (22%) involved non-compliant patients. Time to stent removal was 57 ± 43 days in the compliant group and 324 ± 156 days in the non-compliant group ( P < 0.001). Common procedure indications included pancreatitis-related complications (n = 61), biliary obstruction (n = 55), and bile leak (n = 35). Predictors of non-compliance included male sex (0.047), history of drug use (P = 0.033), and absence of a working phone number ( P = 0.017) or email address ( P = 0.003), electronic medical record access ( P < 0.001), or primary care provider ( P = 0.034) before the procedure.

Conclusions: Patient-specific risk factors for non-compliance of stent removal were identified. Patients with such risk factors may require extra education and communication efforts.

Background and study aims: Device-assisted enteroscopy (DAE) offers a comprehensive examination of the gastrointestinal tract, yet its diagnostic and therapeutic success is dependent on adequate bowel preparation. Current methods for assessing preparation quality are subjective and limited to specific gastrointestinal segments. Although prior research explored artificial intelligence models for colon preparation classification, this study aimed to develop a convolutional neural network (CNN) for automatic evaluation of bowel cleanliness in DAE, addressing both small bowel and colon cleansing.

Patients and methods: We retrospectively analyzed 28 procedures (single balloon, double-balloon, and motorized spiral enteroscopy from January 2023 to May 2024). Bowel preparation was graded as excellent (≥ 90% visible mucosa), satisfactory (50%-90%), or unsatisfactory (< 50%). A dataset of 88,623 images (training: 90%, testing: 10%) was used, covering both small bowel and colon areas. CNN performance was evaluated against expert consensus using sensitivity, specificity, accuracy, and area under a receiver operating characteristic (AUC-ROC).

Results: The CNN demonstrated the following performance metrics: excellent cleansing (sensitivity: 97.8%, specificity: 80.3%, accuracy: 90.6%, AUC-ROC: 0.95), satisfactory cleansing (sensitivity: 81.8%, specificity: 97.9%, accuracy: 92.7%, AUC-ROC: 0.95), and unsatisfactory cleansing (sensitivity: 68.7%, specificity: 99.5%, accuracy: 96.8%, AUC-ROC: 0.96).

Conclusions: Current bowel cleanliness assessment methods are subjective and region-specific. This study presents the first CNN capable of panendoscopic bowel cleanliness evaluation during DAE, achieving high accuracy and demonstrating potential for real-time clinical application. This study marks a key step toward standardizing cleanliness assessment and endoscopy quality improvement.

Background and study aims: Indigo carmine chromoendoscopy (IC) enhances diagnosis of early gastric cancer (EGC), but its clinical application is limited by procedure complexity and time. We developed a deep-learning system using a cycle-consistent generative adversarial network (CycleGAN) to generate virtual IC images from white-light endoscopy (WLE) and evaluated visibility of EGC in video-based virtual IC in a pilot study.

Patients and methods: We collected 4,096 endoscopic still images (2,089 WLE, 2,007 real IC) from 262 patients with gastric neoplasms. A CycleGAN model was trained to convert WLE into virtual IC images, and videos with 512 × 512 pixels at 30 frames per second were generated for five EGC cases. For each case, WLE, real IC, and virtual IC videos were prepared and evaluated by 16 endoscopists (6 experts, 10 non-experts). Visibility relative to WLE was rated using a 7-point Likert-type scale (-3 to +3), with positive values indicating improved visibility.

Results: A total of 160 evaluations were performed. Median [IQR] visibility score was 1 [0-2)] for real IC and 0 [-1 to 1] for virtual IC ( P < 0.001). In virtual IC, 46.3% of cases achieved a score of +1 or higher. Scores significantly varied by endoscope system ( P < 0.001).

Conclusions: Virtual IC improved visibility compared with WLE in nearly half the assessments, although its efficacy did not equal real IC. Optimizing performance for specific endoscope systems may enhance its clinical utility as a practical alternative for improving EGC detection.

Techniques of interventional endoscopy such as implantation of stents, leak closure by clips, or endoscopic suturing can help in reducing risk of an unfavorable outcome for patients with fistulas in the gastrointestinal tract. One method is endoscopic internal drainage (EID), which has been reported to have remarkable success. Because dislocation can reduce success, endoscopic suture techniques have been applied; however, devices could be cumbersome and/or expensive. The purpose of this experimental study was to evaluation the new endoscopic suturing needle-holder SutuArt for fixation of internal drains at a gastric fistula site. This suturing system is a through-the-scope needle-holder, which can be rotated within the working channel 360 degrees and maneuvered with the endoscope tip in many positions. The experiment was performed using an explanted porcine stomach with attached esophagus. Three consecutive running stitches were performed to provide sufficient fixation of the drain at an experimental "fistula" site. Afterward, the force was measured to dislocate the fixed drain. The results of 12 measurements (median duration 23 minutes; range: 19-44) at 6.7 Newton were compared with the reference value of 12 Newton (full-thickness open-stitch), thus withstanding a substantial pulling force. In conclusion, this study demonstrates the conceptual possibility of using an endoscopic needle holder for suture-fixation of a drain. Further clinical investigations are required to establish a full feasibility test of the concept.