Endoscopy International Open最新文献

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.

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.

Background and study aims: Non-ampullary duodenal polyps account for a group of rare tumors of the gastrointestinal tract. Although small lesions are relatively easy to remove, resection of larger lesions requires more advanced techniques such as endoscopic mucosal resection (EMR). Although this technique is considered safe, the most prevalent complication is delayed bleeding (DB) with considerable incidence rates of up to 26%. In this study, we aimed to assess whether prophylactic clipping (PC) reduces DB rates after EMR of large duodenal non-ampullary lateral spreading lesions.

Patients and methods: We retrospectively collected data from consecutive duodenal EMRs of non-ampullary lateral spreading lesions ≥ 15 mm performed between 2019 and 2022 at two medical centers in the Netherlands and Germany.

Results: A total of 186 polyps with a mean size of 25 mm were included in this study. Most were tubular adenomas (55%) and contained low-grade dysplasia (84%). PC of the resection site was performed in 84 patients (45%). The overall DB rate was 13% (24/186). DB occurred in three of 84 cases with PC versus 21 of 102 cases without PC (4% versus 21%, P < 0.01). With an odds ratio of 0.22, multivariable analysis indicated that PC significantly reduced DB (95% confidence interval 0.06-0.85; P = 0.03).

Conclusions: PC of the resection site significantly reduced DB after EMR of large non-ampullary duodenal lateral spreading lesions.

Background and study aims: Gastric cancer is a recently recognized challenge in management of familial adenomatous polyposis (FAP), mostly developing in the proximal stomach amid carpeting fundic gland polyposis. Dysplastic lesions in the proximal stomach might be the precursor lesions for gastric cancer in FAP. We aimed to describe incidence of dysplastic lesions in the proximal stomach and to identify risk factors for these dysplastic lesions.

Patients and methods: Data were collected from FAP patients who had undergone esophagogastroduodenoscopy (EGD) between 2015 and 2023 at our academic center. To identify putative risk factors for dysplastic lesions in the proximal stomach, we used multivariable Cox proportional hazard regression modeling.

Results: Among the 196 FAP patients who underwent EGD at our center, 33 (17%) were diagnosed with dysplastic lesions in the proximal stomach. In total 61% were female and median age at diagnosis was 49 years (range 19-80). A total of 105 dysplastic lesions were identified. Ten (9.5%) showed high-grade dysplasia. During the study period, seven patients were diagnosed with gastric cancer. Carpeting fundic gland polyposis (≥ 100 polyps) (hazard ratio [HR] 8.94; P < 0.001), biliary reflux (HR 1.92; P = 0.017), and proton pump inhibitors (HR 1.78; P = 0.014) were significant predictors of dysplastic lesions in the proximal stomach. Advanced Spigelman stage (III/IV) (HR 0.37; P < 0.001) was associated with a significantly lower risk.

Conclusions: Carpeting fundic gland polyposis, biliary reflux, and use of PPIs were identified as putative risk factors for dysplastic lesions in the proximal stomach. Presence of these risk factors should alert endoscopists to assess the stomach more thoroughly.

Background and study aims: Color vision deficiency (CVD) may affect perception of color information in gastrointestinal endoscopy. However, the color-universal concept in endoscopy remains underappreciated. We hypothesized that image-enhanced endoscopy (IEE) could improve object/lesion visibility regardless of CVD and tested this hypothesis with volunteers of varying color vision characteristics.

Methods: Sixty objects/lesions (20 each of submucosal vessels during colorectal endoscopic submucosal dissection, superficial esophageal cancer, and early gastric cancer) were evaluated. Images with WLI and IEE (red dichromatic imaging [RDI], narrow-band imaging [NBI], or indigo carmine) were assessed for each object/lesion. Twenty evaluators (9 with general color vision: Type C and 11 with two types of CVD [7 with protanopia: Type P and 4 with deuteranopia: Type D]) scored vessel and lesion visibility using a four-level scale.

Results: RDI significantly improved the visibility of submucosal vessels in Types P and D ( P < 0.0001) compared with WLI, but not in Type C. NBI significantly improved visibility of superficial esophageal cancer compared with WLI in all color vision types ( P < 0.0001). Indigo carmine significantly improved visibility of early gastric cancer compared with WLI in all color vision types ( P < 0.0001). Although visibility scores under WLI were significantly higher in Type C compared with Types P and D for all objects/lesions, intergroup differences appeared smaller under IEE due to improved visibility in Types P and D.

Conclusions: IEE improves visibility of objects/lesions where color information plays a role in detection, regardless of CVD.

Background and study aims: Endocuff Vision (EV) is a disposable device designed to improve polyp detection. The primary aim of this study was to evaluate the effect of EV on adenoma detection rate (ADR) and mean number of adenomas per patient (MAP).

Patients and methods: This multicenter randomized controlled trial compared EV-assisted colonoscopy (EAC) and standard colonoscopy (SC). Patients were referred due to a positive fecal immunochemical test (FIT) in a bowel cancer screening program (BCSP), direct screening colonoscopy without prior FIT, surveillance colonoscopy, or family history of colorectal cancer.

Results: In total, 1437 patients (55.9% male; median age, 59 years) were randomized at eight Spanish university hospitals. No significant differences were found in either the ADR (EAC vs. SC, 55.8% vs. 54.3%; P = 0.576) or the MAP (1.60 vs. 1.35; P = 0.03). Compared with SC, EAC was not associated with a significant improvement in detection rates for advanced adenomas, sessile serrated lesions, or advanced sessile serrated lesions. There was no difference in cecal intubation rate but the successful ileal intubation rate, among patients in whom it was attempted, was lower with EAC (64.3% vs. 86.5% with SC; P = 0.001).

Conclusions: EV did not improve either ADR or MAP. EV may increase difficulty of ileal intubation whenever it is attempted.